Int J Equity Health. 2013 Aug 20;12:61. doi: 10.1186/1475-9276-12-61.
The number of subjects with tuberculosis (TB) presenting with co-occurrence of multiple chronic medical conditions, or multimorbidity (MM) is increasing in Brazil. This manuscript aimed to characterize subjects with TB, according to their MM status and to analyse factors associated with TB treatment outcomes.
This is a cross-sectional study that included 39,881 TB subjects reported in Brazil, in 2011. MM were defined as any (two or more) occurrence of chronic medical conditions in a TB patient (TB-MM). Data analysis was performed by hierarchical logistic regression models comparing TBMM with those with only TB.
Of the reported TB cases in 2011, 454 (1.14%) had MM. The subjects in the age group 40-59 years (OR: 17.89; 95% CI, 5.71-56.03) and those ≥ 60 years (OR: 44.11; 95% CI, 14.09-138.06) were more likely to develop TB-MM. The TB-MM subjects were less likely to be male (OR: 0.63; 95% CI, 0.52-0.76), institutionalized (OR: 0.59; 95% CI, 0.23-0.80) and live in rural areas (OR: 0.63; 95% CI, 0.42-0.95). Death from causes other than TB was higher among TB-MM subjects (OR: 1.76; 95% CI, 1.36-2.28). Of 454 TB-MM subjects 302 (66.5%) were cured and 152 (33.5%) were not cured. The odds of not being cured was 1.55 (95% CI, 1.04-2.32) among males, 2.85 (95% CI, 1.12-7.28) among institutionalized subjects, and 3.93 (IC 95%, 1.86-8.30) among those who were infected with HIV. TB retreatment after previous abandonment (OR: 7.53; 95% CI, 2.58-21.97) and transfer from a treatment site (OR: 2.76; 95% CI, 1.20-6.38) were higher for subjects not cured compared to those who were cured.
While TB is well recognized to be a disease engendered by social inequity, we found that even among TB patients, those who have MM have greater inequity in terms of socioeconomic status and adverse clinical outcomes. Addressing the problem of TB and TB-MM requires a multisectorial approach that includes health and social service organizations.
在巴西，患有结核病（TB）并同时患有多种慢性疾病，即合并症（MM）的患者人数正在增加。本文旨在根据合并症的状况来描述 TB 患者，并分析与 TB 治疗结果相关的因素。
这是一项横断面研究，纳入了 2011 年巴西报告的 39881 例 TB 患者。MM 定义为 TB 患者中任何（两种或多种）慢性疾病的发生（TB-MM）。数据分析采用分层逻辑回归模型，比较了 TB-MM 与仅患有 TB 的患者。
2011 年报告的 TB 病例中，有 454 例（1.14%）有 MM。40-59 岁（OR：17.89；95%CI，5.71-56.03）和≥60 岁（OR：44.11；95%CI，14.09-138.06）的患者更有可能发生 TB-MM。与未患有 MM 的 TB 患者相比，TB-MM 患者中男性（OR：0.63；95%CI，0.52-0.76）、住院（OR：0.59；95%CI，0.23-0.80）和居住在农村地区（OR：0.63；95%CI，0.42-0.95）的比例较低。TB-MM 患者死于 TB 以外的其他原因的比例较高（OR：1.76；95%CI，1.36-2.28）。在 454 例 TB-MM 患者中，302 例（66.5%）治愈，152 例（33.5%）未治愈。与治愈患者相比，男性（OR：1.55；95%CI，1.04-2.32）、住院患者（OR：2.85；95%CI，1.12-7.28）和 HIV 感染者（OR：3.93；95%CI，1.86-8.30）未治愈的可能性更高。与治愈患者相比，先前因放弃治疗而再次治疗（OR：7.53；95%CI，2.58-21.97）和从治疗地点转移（OR：2.76；95%CI，1.20-6.38）的比例更高。
尽管结核病被认为是一种由社会不平等引发的疾病，但我们发现，即使在结核病患者中，患有 MM 的患者在社会经济地位和不良临床结局方面也存在更大的不平等。解决结核病和结核病-MM 的问题需要多部门方法，包括卫生和社会服务组织。
