International School of Public Health, Tbilisi State Medical University, 33 Vazha-Pshavela Ave, 0177 Tbilisi, Georgia.
BMC Public Health. 2014 Jan 29;14:88. doi: 10.1186/1471-2458-14-88.
Poverty is associated with increased risk of active tuberculosis (TB) disease onset, but the relation between household income and TB treatment outcomes is not well understood. The objective of this study was to determine household income characteristics associated with poor TB treatment outcome among newly diagnosed patients with pulmonary TB in the country of Georgia.
A prospective cohort study was conducted among newly diagnosed smear positive pulmonary TB patients. Clinical and household data were collected from all consecutive patients seeking care at TB facilities in two major cities and one rural region in Georgia. Patients were followed prospectively during anti-TB regimens to determine treatment outcome. Bivariate analyses were used to determine the association of individual patient and household level characteristics with poor TB treatment outcome. A multivariable logistic model was used to estimate the adjusted association between patient household characteristics and poor TB treatment outcome.
After six months TB therapy, treatment outcome was available for 193 of 202 enrolled patients, of these 155 (80.3%) had a favorable TB treatment outcome. Compared to TB patients with poor treatment outcome, those with favorable treatment outcomes were younger (median 33.0 vs. 42.5 years), reported higher household monthly income (median $137 USD vs. $85 USD), were less likely to be unemployed (38.7 vs. 47.4%), and had higher level of education (38.7% vs. 31.6% with college education or greater). In multivariable analysis adjusted for age, sex, and socio-economic indicators, only low household income was remained statistically significantly associated with poor TB treatment outcome. Compared with patients from households with the highest tertile of monthly income, those in the middle tertile (aOR 4.28 95% CI 1.36, 13.53) and those in the lowest category of income (aOR 6.18 95% CI 1.83, 20.94) were significantly more likely to have poor treatment outcomes.
We demonstrated that TB patients in Georgia with lower household income were at greater risk of poor TB treatment outcomes. Providing targeted social assistance to TB patients and their households may improve clinical response to anti-TB therapy.
贫困与活动性肺结核（TB）发病风险增加相关，但家庭收入与 TB 治疗结果之间的关系尚不清楚。本研究的目的是确定与格鲁吉亚新诊断为肺结核的患者不良 TB 治疗结果相关的家庭收入特征。
对两所主要城市和一个农村地区的结核病防治机构就诊的新诊断为涂片阳性肺结核患者进行了前瞻性队列研究。从所有连续患者收集临床和家庭数据，以确定治疗结果。使用二变量分析来确定患者和家庭水平特征与不良 TB 治疗结果之间的关联。使用多变量逻辑模型来估计患者家庭特征与不良 TB 治疗结果之间的调整关联。
在六个月的抗结核治疗后，可获得 202 名入组患者中的 193 名的治疗结果，其中 155 名（80.3%）有良好的 TB 治疗结果。与治疗结果不良的 TB 患者相比，治疗结果良好的患者年龄更小（中位数 33.0 岁 vs. 42.5 岁），家庭月收入更高（中位数 137 美元 vs. 85 美元），失业可能性更低（38.7% vs. 47.4%），受教育程度更高（38.7% vs. 31.6%有大学或以上学历）。在调整年龄、性别和社会经济指标后进行多变量分析，只有低收入家庭与不良 TB 治疗结果仍具有统计学显著相关性。与来自家庭收入最高三分位数的患者相比，处于中间三分位数（比值比 4.28 95%置信区间 1.36, 13.53）和收入最低类别的患者（比值比 6.18 95%置信区间 1.83, 20.94）更有可能出现不良治疗结局。
我们证明格鲁吉亚的 TB 患者家庭收入较低，其不良 TB 治疗结果的风险更高。向 TB 患者及其家庭提供有针对性的社会援助可能会改善对抗结核治疗的临床反应。
