Hansel Nadia N, Merriman Barry, Haponik Edward F, Diette Gregory B
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Room 577, 1830 East Monument St, Baltimore, MD 21205, USA.
Chest. 2004 Oct;126(4):1079-86. doi: 10.1378/chest.126.4.1079.
Despite curative therapy, mortality remains high for hospitalized patients with tuberculosis (TB) in the United States. The purpose of this study was to describe the characteristics of hospitalized patients with TB and to identify patient characteristics associated with in-hospital mortality.
DESIGN, SETTING, AND PATIENTS: Using the 2000 Nationwide Inpatient Sample, representing 20% of US hospital admissions, we identified 2,279 hospital admissions with a primary diagnosis of TB (International Classification of Diseases, ninth revision, codes, 010.xx to 018.xx).
Mortality was the main outcome measure. Logistic regression analyses were performed including age, gender, race, insurance status, income, Deyo-adapted Charlson comorbidity index (DCI), HIV status, hospital admission source, and hospital characteristics as explanatory variables. A disproportionate number of patients hospitalized with TB were men (64%), nonwhite (72%), lived in areas with median incomes of < $35,000 (50%), and had publicly funded health insurance (49%) or no health insurance (17%). The mortality rate for patients hospitalized for TB was greater than that for non-TB hospital admissions (4.9% vs 2.4%, respectively; p < 0.001). Patients with TB who died during hospitalization were older (mean age, 65.1 vs 49.4 years, respectively; p < 0.001), had greater comorbid illness (DCI, 1.1 vs 0.55, respectively; p < 0.001), required longer hospitalizations (19.9 vs 13.9 days, respectively; p < 0.001), and accumulated substantially higher charges ($79,585 vs $31,610, respectively; p < 0.001) than did patients with TB who were alive at hospital discharge. In a multivariable analysis, older age, comorbid illnesses, and emergency department admissions were independently associated with mortality. The total charges for TB hospitalizations in the United States in 2000 exceeded $385 million.
Despite public health efforts, patients who are hospitalized with TB are frequently admitted through emergency care settings, have a high risk of in-hospital mortality, and incur substantial hospital charges. To improve TB health outcomes, more vigorous clinical management and prevention strategies should especially target older patients and those with comorbid medical conditions.
在美国，尽管进行了治愈性治疗，但住院结核病（TB）患者的死亡率仍然很高。本研究的目的是描述住院结核病患者的特征，并确定与住院死亡率相关的患者特征。
设计、地点和患者：利用代表美国20%住院患者的2000年全国住院患者样本，我们确定了2279例以结核病为主要诊断的住院病例（国际疾病分类第九版，编码010.xx至018.xx）。
死亡率是主要的结局指标。进行了逻辑回归分析，将年龄、性别、种族、保险状况、收入、Deyo改编的Charlson合并症指数（DCI）、HIV状况、住院来源和医院特征作为解释变量。因结核病住院的患者中，男性比例过高（64%），非白人比例过高（72%），居住在收入中位数低于35000美元地区的比例过高（50%），拥有公共资助医疗保险的比例过高（49%）或没有医疗保险的比例过高（17%）。结核病住院患者的死亡率高于非结核病住院患者（分别为4.9%和2.4%；p<0.001）。住院期间死亡的结核病患者年龄更大（平均年龄分别为65.1岁和49.4岁；p<0.001），合并症更多（DCI分别为1.1和0.55；p<0.001），住院时间更长（分别为19.9天和13.9天；p<0.001），与出院时存活的结核病患者相比，费用也大幅更高（分别为79585美元和31610美元；p<0.001）。在多变量分析中，年龄较大、合并症和急诊科入院与死亡率独立相关。2000年美国结核病住院的总费用超过3.85亿美元。
尽管开展了公共卫生工作，但结核病住院患者经常通过急诊途径入院，住院死亡率高，住院费用高。为改善结核病的健康结局，更积极的临床管理和预防策略应特别针对老年患者和有合并症的患者。
