Ncube R T, Takarinda K C, Zishiri C, van den Boogaard W, Mlilo N, Chiteve C, Siziba N, Trinchán F, Sandy C
International Union Against Tuberculosis and Lung Disease (The Union), Zimbabwe Country Office, Harare, Zimbabwe.
Centre for Operations Research, The Union, Paris, France.
Public Health Action. 2017 Sep 21;7(3):212-217. doi: 10.5588/pha.17.0024.
A high tuberculosis (TB) incidence, resource-limited urban setting in Zimbabwe. To compare treatment outcomes among people initiated on first-line anti-tuberculosis treatment in relation to age and other explanatory factors. This was a retrospective record review of routine programme data. Of 2209 patients included in the study, 133 (6%) were children (aged <10 years), 132 (6%) adolescents (10-19 years), 1782 (81%) adults (20-59 years) and 162 (7%) were aged ⩾60 years, defined as elderly. The highest proportion of smear-negative pulmonary TB cases was among the elderly (40%). Unfavourable outcomes, mainly deaths, increased proportionately with age, and were highest among the elderly (adjusted relative risk 3.8, 95%CI 1.3-10.7). Having previous TB, being human immunodeficiency virus positive and not on antiretroviral treatment or cotrimoxazole preventive therapy were associated with an increased risk of unfavourable outcomes. The elderly had the worst outcomes among all the age groups. This may be related to immunosuppressant comorbidities or other age-related diseases mis-classified as TB, as a significant proportion were smear-negative. Older persons need better adapted TB management and more sensitive diagnostic tools, such as Xpert MTB/RIF.
津巴布韦一个结核病发病率高且资源有限的城市环境。比较一线抗结核治疗起始患者中不同年龄及其他解释因素的治疗结果。这是一项对常规项目数据的回顾性记录审查。纳入研究的2209例患者中，133例（6%）为儿童（年龄<10岁），132例（6%）为青少年（10 - 19岁），1782例（81%）为成年人（20 - 59岁），162例（7%）年龄≥60岁，定义为老年人。涂片阴性肺结核病例比例最高的是老年人（40%）。不良结局，主要是死亡，随年龄成比例增加，在老年人中最高（调整后相对风险3.8，95%置信区间1.3 - 10.7）。既往有结核病、人类免疫缺陷病毒阳性且未接受抗逆转录病毒治疗或复方新诺明预防性治疗与不良结局风险增加相关。在所有年龄组中，老年人的结局最差。这可能与免疫抑制合并症或其他被误诊为结核病的年龄相关疾病有关，因为相当一部分病例为涂片阴性。老年人需要更合适的结核病管理和更敏感的诊断工具，如Xpert MTB/RIF。
