Zerbini Elsa, Greco Adriana, Estrada Silvia, Cisneros Mario, Colombo Carlos, Beltrame Soledad, Boncompain Carina, Genero Sebastián
Instituto Nacional de Enfermedades Respiratorias Dr. Emilio Coni (ANLIS Malbrán), Santa Fe, Argentina. E-mail:
Programa Nacional de Control de Tuberculosis, Argentina.
Medicina (B Aires). 2017;77(4):267-273.
Tuberculosis (TB) remains a cause of illness and death across the world, especially in developing countries and vulnerable population groups. In 2013, 1.5 million died from the disease worldwide. In Argentina, the largest proportion of TB-related deaths occurred in the northern provinces. Several international studies reported that TB mortality was related to the presence of certain comorbidities and socio-demographic characteristics. Our aim was to investigate the main risk factors associated with TB mortality in adults from six provinces in Argentina, especially those with higher TB mortality rates. A retrospective case-control study was conducted. It included all patients of =18 years with clinical and/or bacteriological TB diagnosis who underwent treatment from January 1st, 2012 to June 30th, 2013. Socio-demographic, clinical and bacteriological variables were surveyed. Information on 157 cases and 281 controls was obtained. Patients reported as deceased to the TB Control Program were considered cases, and those whose treatment result was reported as successful in the same time period were considered controls. For 111 deaths, the average time elapsed between the start of treatment and death was 2.3 months; median: 1. TB-related mortality was associated with poor TB treatment adherence (OR: 3.7 [1.9-7.3], p: 0.000), AIDS (OR: 5.29 [2.6-10.7], p: 0.000), male gender (OR: 1.7 [1.1-2.5], p: 0.009), belonging to indigenous people (OR: 7.2 [2.8-18.9], p:0. 000) and age = 50 (OR: 2.2 [1.4-3.3], p: 0.000). By multivariate analysis the two first associations were confirmed. This study sets up the basis for planning inter-program and inter-sector work to accelerate the decline in the inequitable TB mortality.
结核病在全球范围内仍是致病和致死原因，尤其在发展中国家和弱势群体中。2013年，全球有150万人死于该病。在阿根廷，与结核病相关的死亡病例大部分发生在北部省份。多项国际研究报告称，结核病死亡率与某些合并症及社会人口学特征有关。我们的目的是调查阿根廷六个省份成年人结核病死亡的主要风险因素，尤其是结核病死亡率较高的地区。开展了一项回顾性病例对照研究。研究纳入了2012年1月1日至2013年6月30日期间接受治疗、年龄≥18岁且临床和/或细菌学诊断为结核病的所有患者。调查了社会人口学、临床和细菌学变量。获取了157例病例和281例对照的信息。向结核病控制项目报告已死亡的患者被视为病例，同期治疗结果报告为成功的患者被视为对照。111例死亡病例中，从治疗开始到死亡的平均时间为2.3个月；中位数为1个月。结核病相关死亡率与结核病治疗依从性差（比值比：3.7[1.9 - 7.3]，p值：0.000）、艾滋病（比值比：5.29[2.6 - 10.7]，p值：0.000）、男性（比值比：1.7[1.1 - 2.5]，p值：0.009）、属于原住民（比值比：7.2[2.8 - 18.9]，p值：0.000）及年龄≥50岁（比值比：2.2[1.4 - 3.3]，p值：0.000）有关。多因素分析证实了前两个关联。本研究为规划跨项目和跨部门工作奠定了基础，以加速降低不公平的结核病死亡率。
