Forssbohm M, Kropp R, Loytved G, Neher A, Simma M, Rabbow M, Becher H
Gesundheitsamt Wiesbaden.
Pneumologie. 2011 Oct;65(10):607-14. doi: 10.1055/s-0030-1256805. Epub 2011 Oct 20.
Tuberculosis (TB) is a curable disease. Nevertheless, patients in Germany also die of TB. Although mortality is decreasing, there are indications for an increase in lethality. This observation provided the impetus for a detailed analysis that sought to investigate the validity of the statistics on deaths caused by TB.
The study population consists of the 926 fatal cases that were classified either as "death from TB" or as "death due to other causes" out of the 6044 TB patients in the DZK study. For the analysis, health authorities were asked to provide additional information and such documents as the death certificate, the autopsy protocol and the final medical report. In 778 cases, there was at least one additional piece of information available. Three teams of two experts each conducted independent evaluations of the documents.
Based on the findings of the experts, every second death caused by TB in 1997 and 1998 was not recorded correctly during the post-mortem examination. Every third TB death was not diagnosed during the patient's lifetime. Patients who died due to TB were, on average, older and more likely to be born in Germany. This indicates that age-related comorbidity among the native German population plays a relevant role. Yet, the unicausal death registration did not acknowledge comorbidity as a contributing factor to the fatal outcome. Pulmonary TB with positive microscopy and culture, miliary TB and meningeal TB were more common among the deaths due to TB than among the general study population, and led more often to a fatal outcome than other organ manifestations. However, the two groups did not differ with regard to multi-drug resistant TB. Alcohol abuse was a leading risk factor for death caused by TB in patients under 65 years. Patient's delay ranged from six to 34 days, and doctor's delay from eight to 46 days. For example, alcohol abusers, on average, visited a physician much later, but were diagnosed more rapidly after the first visit than patients who were not alcohol-dependent. A period of 32 - 200 days elapsed between diagnosis and death caused by TB.
The post-mortem examination often missed TB as the cause of death. Many native German TB patients showed age-related comorbidity. Pulmonary TB with positive microscopy, miliary TB and meningeal TB led more often to a fatal outcome than other organ manifestations. Alcohol abuse was a leading risk factor for TB deaths in patients younger the 65 years. The average period between the onset of symptoms and the diagnosis was significantly longer than the one month generally considered acceptable. The experts could not confirm an increase in lethality for the period under investigation.
结核病是一种可治愈的疾病。然而，德国仍有患者死于结核病。尽管死亡率在下降，但有迹象表明致死率在上升。这一观察结果促使我们进行详细分析，以调查结核病致死统计数据的有效性。
研究人群包括DZK研究中6044例结核病患者中被归类为“死于结核病”或“死于其他原因”的926例死亡病例。为进行分析，要求卫生当局提供额外信息以及死亡证明、尸检报告和最终医疗报告等文件。在778例病例中，至少有一条额外信息可用。三个由两名专家组成的小组对这些文件进行了独立评估。
根据专家的调查结果，1997年和1998年每两例由结核病导致的死亡在尸检时都未被正确记录。每三例结核病死亡在患者生前未被诊断出来。死于结核病的患者平均年龄更大，且更有可能出生在德国。这表明德国本土人群中与年龄相关的合并症起着重要作用。然而，单因死亡登记并未将合并症视为导致致命结局的一个因素。显微镜检查和培养呈阳性的肺结核、粟粒性肺结核和结核性脑膜炎在结核病死亡病例中比在一般研究人群中更常见，并且比其他器官表现更常导致致命结局。然而，两组在耐多药结核病方面没有差异。酗酒是65岁以下患者结核病死亡的主要危险因素。患者延迟就医时间为6至34天，医生延迟诊断时间为8至46天。例如，酗酒者平均就医时间要晚得多，但首次就诊后比非酒精依赖患者诊断得更快。从结核病诊断到死亡的时间间隔为32至200天。
尸检经常遗漏结核病作为死亡原因。许多德国本土结核病患者表现出与年龄相关的合并症。显微镜检查呈阳性的肺结核、粟粒性肺结核和结核性脑膜炎比其他器官表现更常导致致命结局。酗酒是65岁以下患者结核病死亡的主要危险因素。症状出现到诊断的平均时间明显长于通常认为可接受的一个月。专家无法证实在调查期间致死率有所上升。
