Risk factors associated with tuberculosis mortality in adults in six provinces of Argentina

ABSTRACT

Tuberculosis (TB) remains a cause of illness and death across the world, especially in developing countries and vulnerable population groups. In 2013, 1.5 million died from the disease worldwide. In Argentina, the largest proportion of TB-related deaths occurred in the northern provinces. Several international studies reported that TB mortality was related to the presence of certain comorbidities and socio-demographic characteristics. Our aim was to investigate the main risk factors associated with TB mortality in adults from six provinces in Argentina, especially those with higher TB mortality rates. A retrospective case-control study was conducted. It included all patients of =18 years with clinical and/or bacteriological TB diagnosis who underwent treatment from January 1st, 2012 to June 30th, 2013. Socio-demographic, clinical and bacteriological variables were surveyed. Information on 157 cases and 281 controls was obtained. Patients reported as deceased to the TB Control Program were considered cases, and those whose treatment result was reported as successful in the same time period were considered controls. For 111 deaths, the average time elapsed between the start of treatment and death was 2.3 months; median 1. TB-related mortality was associated with poor TB treatment adherence (OR 3.7 [1.9-7.3], p 0.000), AIDS (OR 5.29 [2.6-10.7], p 0.000), male gender (OR 1.7 [1.1-2.5], p 0.009), belonging to indigenous people (OR 7.2 [2.8-18.9], p0. 000) and age = 50 (OR 2.2 [1.4-3.3], p 0.000). By multivariate analysis the two first associations were confirmed. This study sets up the basis for planning inter-program and inter-sector work to accelerate the decline in the inequitable TB mortality.

RESUMEN

En 2013, 1.5 millones de personas murieron por tuberculosis (TB) en el mundo, especialmente en países en desarrollo y grupos de población vulnerables. En Argentina, la mayor proporción de muertes asociadas con TB ocurrió en las provincias del norte. Estudios internacionales observaron que la mortalidad por TB estaba relacionada con comorbilidades y características sociodemográficas. Este estudio pretendió investigar cuáles eran los principales factores de riesgo asociados con la mortalidad por TB en adultos de seis provincias argentinas, especialmente aquellas con mayores tasas de mortalidad por TB. Se realizó un estudio retrospectivo casos-controles, incluyendo todos los pacientes = 18 años con diagnóstico clínico y/o bacteriológico de TB en tratamiento entre el 1° de enero de 2012 y el 30 de junio de 2013. Se obtuvo información de 157 casos y 281 controles, considerándose casos los pacientes notificados como fallecidos al Programa de TB y controles aquellos cuyo resultado de tratamiento fue notificado como éxito o curado en el mismo período de tiempo. El tiempo transcurrido entre el comienzo del tratamiento y la muerte fue 2.3 meses; mediana 1. Las muertes relacionadas con TB estuvieron asociadas con escasa adherencia al tratamiento (OR 3.7 [1.9-7.3], p 0.000), sida (OR 5.29 [2.6-10.7], p 0.000), género masculino (OR 1.7 [1.1-2.5], p 0.009), pertenencia a pueblos originarios (OR 7.2 [2.8-18.9], p 0.000) y edad = 50 (OR 2.2 [1.4-3.3], p 0.000). Por análisis multivariado, se confirmaron las dos primeras asociaciones. Este estudio sienta las bases para planificar acciones destinadas a acelerar el descenso de la mortalidad por TB.