Comorbidities, mortality and causes of death among patients with tuberculosis in Denmark 1998-2010: a nationwide, register-based case-control study

Abstract

Objective: To evaluate the impact of comorbidities, age and clinical presentation of TB on mortality among Danish patients with TB.

Methods: Danish patients with an ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision) diagnosis of TB in 1998-2010 were identified in the National Patient Registry and matched with controls (1:4) on age, gender, civil status and geography. Comorbid diagnoses up to 3 years before and after TB diagnosis or enrolment as control as well as survival data were obtained from national databases RESULTS: We included 8433 cases and 33 707 controls. Respiratory diseases were the most common comorbidities among cases (12.4% of cases, 3.8% of controls (p<0.001)). Overall HR of death was 2.45 (2.31; 2.59). Relative mortality was especially increased among younger adults (HR 8.70 (95% CI 5.53 to 13.69) among the 30 to 39-year-olds). While overall mortality increased with Deyo-Charlson comorbidity (DCC) score, relative mortality among cases was highest in the low-DCC group. Additionally, male gender, low income and central nervous system TB were risk factors for death among TB cases. The most common cause of death in both groups was non-lung cancers, among TB cases followed by COPD, TB and lung cancer, all being significantly more common among TB cases.

Conclusion: In Denmark, TB carries substantial mortality. Among those who die, 12% are reported to die from TB. A high relative mortality among younger adults underscores the importance of continually targeting high-risk TB groups in low-incidence countries.

Keywords: case-control study; cause of death; comorbidity; mortality; tuberculosis.