Faculty of Medicine and Health, University of Sydney, Australia.
Woolcock Institute of Medical Research, Glebe, New South Wales, Australia.
Clin Infect Dis. 2019 Apr 8;68(8):1359-1366. doi: 10.1093/cid/ciy665.
Tuberculosis is the leading infectious cause of death. Steep reductions in tuberculosis-related mortality are required to realize the World Health Organization's "End Tuberculosis Strategy." However, accurate mortality estimates are lacking in many countries, particularly following discharge from care. This study aimed to establish the mortality rate among patients with pulmonary tuberculosis in Vietnam and to quantify the excess mortality in this population.
We conducted a prospective cohort study among adult patients treated for smear-positive pulmonary tuberculosis in 70 clinics across Vietnam. People living in the same households were recruited as controls. Participants were re-interviewed and their survival was established at least 2 years after their treatment with an 8-month standardized regimen. The presence of relapse was established by linking identifying data on patients and controls to clinic registries. Verbal autopsies were performed. The cumulative mortality among patients was compared to that among a control population, adjusting for age and gender.
We enrolled 10964 patients and 25707 household controls. Among enrolled tuberculosis patients, 9% of patients died within a median follow-up period of 2.9 years: 342 (3.1%) during treatment and 637 (5.8%) after discharge. The standardized mortality ratio was 4.0 (95% confidence interval 3.7-4.2) among patients with tuberculosis, compared to the control population. Tuberculosis was the likely cause of death for 44.7% of these deceased patients.
Patients treated for tuberculosis had a markedly elevated risk of death, particularly in the post-treatment period. Interventions to reduce tuberculosis mortality must enhance the early detection of drug-resistance, improve treatment effectiveness, and address non-communicable diseases.
结核病是导致死亡的主要传染病。为了实现世界卫生组织的“终结结核病策略”,必须大幅降低结核病相关死亡率。然而,许多国家缺乏准确的死亡率估计,尤其是在患者出院后。本研究旨在确定越南肺结核患者的死亡率,并量化该人群的超额死亡率。
我们在越南 70 家诊所对接受涂片阳性肺结核治疗的成年患者进行了前瞻性队列研究。同住一家庭的人被招募为对照。在患者接受标准化 8 个月疗程治疗至少 2 年后,对其进行重新访谈并确定其生存情况。通过将患者和对照者的识别数据与诊所登记处相联系,确定复发的存在。进行了口头尸检。将患者的累积死亡率与对照人群进行比较,同时调整年龄和性别因素。
我们共纳入了 10964 名患者和 25707 名家庭对照。在纳入的肺结核患者中,9%的患者在 2.9 年的中位随访期内死亡:342 例(3.1%)在治疗期间,637 例(5.8%)在出院后。与对照人群相比,结核病患者的标准化死亡率比为 4.0(95%置信区间 3.7-4.2)。这些死亡患者中,有 44.7%的人可能死于结核病。
接受结核病治疗的患者死亡风险明显升高,尤其是在治疗后时期。为降低结核病死亡率,必须加强对耐药性的早期检测,提高治疗效果,并解决非传染性疾病问题。