Tuberculosis mortality in the United States

Epidemiology and prevention opportunities

on behalf of the Tuberculosis Epidemiologic Studies Consortium

Research output: Contribution to journalArticleResearchpeer-review

3 Citations (Scopus)

Abstract

Rationale: More information on risk factors for death from tuberculosis in the United States could help reduce the tuberculosis mortality rate, which has remained steady for more than a decade. Objective: To identify risk factors for tuberculosis-related death in adults. Methods: We performed a retrospective study of 1,304 adults with tuberculosis who died before treatment completion and 1,039 frequency-matched control subjects who completed tuberculosis treatment in 2005 to 2006 in 13 states reporting 65% of U.S. tuberculosis cases. We used in-depth record abstractions and a standard algorithm to classify deaths in persons with tuberculosis as tuberculosis-related or not. We then compared these classifications to causes of death as coded in death certificates. We used multivariable logistic regression to calculate adjusted odds ratios for predictors of tuberculosis-related death among adults compared with those who completed tuberculosis treatment. Results: Of 1,304 adult deaths, 942 (72%) were tuberculosis related, 272 (21%) were not, and 90 (7%) could not be classified. Of 847 tuberculosis-related deaths with death certificates available, 378 (45%) did not list tuberculosis as a cause of death. Adjusting for known risks, we identified new risks for tuberculosis-related death during treatment: absence of pyrazinamide in the initial regimen (adjusted odds ratio, 3.4; 95% confidence interval, 1.9-6.0); immunosuppressive medications (adjusted odds ratio, 2.5; 95% confidence interval, 1.1-5.6); incomplete tuberculosis diagnostic evaluation (adjusted odds ratio, 2.2; 95% confidence interval, 1.5-3.3), and an alternative nontuberculosis diagnosis before tuberculosis diagnosis (adjusted odds ratio, 1.6; 95% confidence interval, 1.2-2.2). Conclusions: Most persons who died with tuberculosis had a tuberculosis-related death. Intensive record review revealed tuberculosis as a cause of death more often than did death certificate diagnoses. New tools, such as a tuberculosis mortality risk score based on our study findings, may identify patients with tuberculosis for in-hospital interventions to prevent death.

Original languageEnglish
Pages (from-to)683-692
Number of pages10
JournalAnnals of the American Thoracic Society
Volume15
Issue number6
DOIs
StatePublished - 1 Jun 2018

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Epidemiology
Tuberculosis
Mortality
Odds Ratio
Death Certificates
Confidence Intervals
Cause of Death
Chronic Disease Hospitals
Pyrazinamide
Immunosuppressive Agents

Keywords

  • Cause of death
  • Death certificates
  • Risk factors

Cite this

on behalf of the Tuberculosis Epidemiologic Studies Consortium. / Tuberculosis mortality in the United States : Epidemiology and prevention opportunities. In: Annals of the American Thoracic Society. 2018 ; Vol. 15, No. 6. pp. 683-692.
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title = "Tuberculosis mortality in the United States: Epidemiology and prevention opportunities",
abstract = "Rationale: More information on risk factors for death from tuberculosis in the United States could help reduce the tuberculosis mortality rate, which has remained steady for more than a decade. Objective: To identify risk factors for tuberculosis-related death in adults. Methods: We performed a retrospective study of 1,304 adults with tuberculosis who died before treatment completion and 1,039 frequency-matched control subjects who completed tuberculosis treatment in 2005 to 2006 in 13 states reporting 65{\%} of U.S. tuberculosis cases. We used in-depth record abstractions and a standard algorithm to classify deaths in persons with tuberculosis as tuberculosis-related or not. We then compared these classifications to causes of death as coded in death certificates. We used multivariable logistic regression to calculate adjusted odds ratios for predictors of tuberculosis-related death among adults compared with those who completed tuberculosis treatment. Results: Of 1,304 adult deaths, 942 (72{\%}) were tuberculosis related, 272 (21{\%}) were not, and 90 (7{\%}) could not be classified. Of 847 tuberculosis-related deaths with death certificates available, 378 (45{\%}) did not list tuberculosis as a cause of death. Adjusting for known risks, we identified new risks for tuberculosis-related death during treatment: absence of pyrazinamide in the initial regimen (adjusted odds ratio, 3.4; 95{\%} confidence interval, 1.9-6.0); immunosuppressive medications (adjusted odds ratio, 2.5; 95{\%} confidence interval, 1.1-5.6); incomplete tuberculosis diagnostic evaluation (adjusted odds ratio, 2.2; 95{\%} confidence interval, 1.5-3.3), and an alternative nontuberculosis diagnosis before tuberculosis diagnosis (adjusted odds ratio, 1.6; 95{\%} confidence interval, 1.2-2.2). Conclusions: Most persons who died with tuberculosis had a tuberculosis-related death. Intensive record review revealed tuberculosis as a cause of death more often than did death certificate diagnoses. New tools, such as a tuberculosis mortality risk score based on our study findings, may identify patients with tuberculosis for in-hospital interventions to prevent death.",
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Tuberculosis mortality in the United States : Epidemiology and prevention opportunities. / on behalf of the Tuberculosis Epidemiologic Studies Consortium.

In: Annals of the American Thoracic Society, Vol. 15, No. 6, 01.06.2018, p. 683-692.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Tuberculosis mortality in the United States

T2 - Epidemiology and prevention opportunities

AU - on behalf of the Tuberculosis Epidemiologic Studies Consortium

AU - Beavers, Suzanne F.

AU - Pascopella, Lisa

AU - Davidow, Amy L.

AU - Mangan, Joan M.

AU - Hirsch-Moverman, Yael R.

AU - Golub, Jonathan E.

AU - Blumberg, Henry M.

AU - Webb, Risa M.

AU - Royce, Rachel A.

AU - Buskin, Susan E.

AU - Leonard, Michael K.

AU - Weinfurter, Paul C.

AU - Belknap, Robert W.

AU - Hughes, Stephen E.

AU - Warkentin, Jon V.

AU - Welbel, Sharon F.

AU - Miller, Thaddeus L.

AU - Kundipati, Saini R.

AU - Lauzardo, Michael

AU - Barry, Pennan M.

AU - Katz, Dolly J.

AU - Garrett, Denise O.

AU - Graviss, Edward A.

AU - Flood, Jennifer M.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Rationale: More information on risk factors for death from tuberculosis in the United States could help reduce the tuberculosis mortality rate, which has remained steady for more than a decade. Objective: To identify risk factors for tuberculosis-related death in adults. Methods: We performed a retrospective study of 1,304 adults with tuberculosis who died before treatment completion and 1,039 frequency-matched control subjects who completed tuberculosis treatment in 2005 to 2006 in 13 states reporting 65% of U.S. tuberculosis cases. We used in-depth record abstractions and a standard algorithm to classify deaths in persons with tuberculosis as tuberculosis-related or not. We then compared these classifications to causes of death as coded in death certificates. We used multivariable logistic regression to calculate adjusted odds ratios for predictors of tuberculosis-related death among adults compared with those who completed tuberculosis treatment. Results: Of 1,304 adult deaths, 942 (72%) were tuberculosis related, 272 (21%) were not, and 90 (7%) could not be classified. Of 847 tuberculosis-related deaths with death certificates available, 378 (45%) did not list tuberculosis as a cause of death. Adjusting for known risks, we identified new risks for tuberculosis-related death during treatment: absence of pyrazinamide in the initial regimen (adjusted odds ratio, 3.4; 95% confidence interval, 1.9-6.0); immunosuppressive medications (adjusted odds ratio, 2.5; 95% confidence interval, 1.1-5.6); incomplete tuberculosis diagnostic evaluation (adjusted odds ratio, 2.2; 95% confidence interval, 1.5-3.3), and an alternative nontuberculosis diagnosis before tuberculosis diagnosis (adjusted odds ratio, 1.6; 95% confidence interval, 1.2-2.2). Conclusions: Most persons who died with tuberculosis had a tuberculosis-related death. Intensive record review revealed tuberculosis as a cause of death more often than did death certificate diagnoses. New tools, such as a tuberculosis mortality risk score based on our study findings, may identify patients with tuberculosis for in-hospital interventions to prevent death.

AB - Rationale: More information on risk factors for death from tuberculosis in the United States could help reduce the tuberculosis mortality rate, which has remained steady for more than a decade. Objective: To identify risk factors for tuberculosis-related death in adults. Methods: We performed a retrospective study of 1,304 adults with tuberculosis who died before treatment completion and 1,039 frequency-matched control subjects who completed tuberculosis treatment in 2005 to 2006 in 13 states reporting 65% of U.S. tuberculosis cases. We used in-depth record abstractions and a standard algorithm to classify deaths in persons with tuberculosis as tuberculosis-related or not. We then compared these classifications to causes of death as coded in death certificates. We used multivariable logistic regression to calculate adjusted odds ratios for predictors of tuberculosis-related death among adults compared with those who completed tuberculosis treatment. Results: Of 1,304 adult deaths, 942 (72%) were tuberculosis related, 272 (21%) were not, and 90 (7%) could not be classified. Of 847 tuberculosis-related deaths with death certificates available, 378 (45%) did not list tuberculosis as a cause of death. Adjusting for known risks, we identified new risks for tuberculosis-related death during treatment: absence of pyrazinamide in the initial regimen (adjusted odds ratio, 3.4; 95% confidence interval, 1.9-6.0); immunosuppressive medications (adjusted odds ratio, 2.5; 95% confidence interval, 1.1-5.6); incomplete tuberculosis diagnostic evaluation (adjusted odds ratio, 2.2; 95% confidence interval, 1.5-3.3), and an alternative nontuberculosis diagnosis before tuberculosis diagnosis (adjusted odds ratio, 1.6; 95% confidence interval, 1.2-2.2). Conclusions: Most persons who died with tuberculosis had a tuberculosis-related death. Intensive record review revealed tuberculosis as a cause of death more often than did death certificate diagnoses. New tools, such as a tuberculosis mortality risk score based on our study findings, may identify patients with tuberculosis for in-hospital interventions to prevent death.

KW - Cause of death

KW - Death certificates

KW - Risk factors

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U2 - 10.1513/AnnalsATS.201705-405OC

DO - 10.1513/AnnalsATS.201705-405OC

M3 - Article

VL - 15

SP - 683

EP - 692

JO - Annals of the American Thoracic Society

JF - Annals of the American Thoracic Society

SN - 2325-6621

IS - 6

ER -