Yen Y-F, Feng J-Y, Pan S-W, Chuang P-H, Su V Y-F, Su W-J
Section of Infectious Diseases,Taipei City Hospital, Taipei City Government,Taipei,Taiwan.
School of Medicine, National Yang-Ming University,Taipei,Taiwan.
Epidemiol Infect. 2017 May;145(7):1374-1381. doi: 10.1017/S0950268817000152. Epub 2017 Feb 13.
Elderly individuals with tuberculosis (TB) are more likely to have a non-specific clinical presentation of TB and high mortality. However, factors associated with mortality in elderly TB patients have not been extensively studied. This retrospective cohort study aimed to identify factors associated with death among elderly Taiwanese with TB. All elderly patients with TB from 2006 to 2014 in Taipei, Taiwan, were included in a study. Multiple logistic regression was used to identify the factors associated with death in elderly TB patients. The mean age of the 5011 patients was 79·7 years; 74·1% were men; 32·7% had mortality during the study follow-up period. After controlling for potential confounders, age ⩾75 years (reference: 65-74 years), male sex, end-stage renal disease (ESRD), malignancy, acid-fast bacilli-smear positivity, TB-culture positivity, pleural effusion on chest radiograph and notification by an ordinary ward or intensive care unit were associated with a higher risk of all-cause death; while high school, and university or higher education, cavity on chest radiograph and directly observed therapy were associated with a lower risk of all-cause death. This study found that the proportion of death among elderly patients with TB in Taipei, Taiwan, was high. To improve TB treatment outcomes, future control programmes should particularly target individuals with comorbidities (e.g. ESRD and malignancy) and those with a lower socio-economic status (e.g. not educated).
患有结核病(TB)的老年人更有可能出现非特异性的结核病临床表现且死亡率较高。然而,老年结核病患者的死亡相关因素尚未得到广泛研究。这项回顾性队列研究旨在确定台湾老年结核病患者的死亡相关因素。2006年至2014年在台湾台北的所有老年结核病患者均纳入本研究。采用多因素逻辑回归分析来确定老年结核病患者的死亡相关因素。5011例患者的平均年龄为79.7岁;74.1%为男性;32.7%在研究随访期间死亡。在控制潜在混杂因素后,年龄≥75岁(参照:65 - 74岁)、男性、终末期肾病(ESRD)、恶性肿瘤、抗酸杆菌涂片阳性、结核菌培养阳性、胸部X线片显示胸腔积液以及由普通病房或重症监护病房收治与全因死亡风险较高相关;而高中及大专以上学历、胸部X线片有空洞以及直接观察治疗与全因死亡风险较低相关。本研究发现,台湾台北老年结核病患者的死亡比例较高。为改善结核病治疗效果,未来的防控项目应特别针对患有合并症(如ESRD和恶性肿瘤)的个体以及社会经济地位较低(如未受过教育)的个体。