TRACK TB Project, Management Sciences for Health, Bugolobi, Kampala, Uganda.
United States Agency for International Development, Kampala, Uganda.
PLoS One. 2018 Dec 19;13(12):e0208390. doi: 10.1371/journal.pone.0208390. eCollection 2018.
While old age is a known risk factor for developing active tuberculosis (TB), studies on TB in the population aged 60 years and older (considered elderly in this study) are few, especially in the developing world. Results of the TB prevalence survey in Uganda found high TB prevalence (570/100,000) in people over 65. We focused on treatment outcomes in the elderly to understand this epidemic better. We conducted a retrospective analysis of data from TB facility registers in Kampala City for the period 2014-2015. We analyzed the 2014-15 cohort with respect to age, sex, disease class, patients' human immunodeficiency virus (HIV) and directly observed therapy (DOT) status, type of facility, and treatment outcomes and compared findings in the elderly (≥60) and younger (<60) age groups. Of 15,429 records, 3.3% (514/15,429) were for elderly patients. The treatment success rate (TSR) among elderly TB patients (68.3%) was lower than that of the non-elderly (80.9%) and the overall TSR 80.5%, (12,417/15,429) in Kampala. Although the elderly were less likely to test positive for HIV than the young (AOR 0.39; 95% CI 0.33-0.48, p<0.001), they had a two-fold higher risk of unfavorable treatment outcomes (AOR 2.14; CI 1.84-2.72, p<0.001) and were more likely to die while on treatment (AOR 1.86; CI 1.27-2.73; p = 0.001). However, there was no statistically significantly difference between treatment outcomes among HIV-positive and HIV-negative elderly TB patients. Compared to the younger TB patients, elderly TB patients have markedly poorer treatment outcomes, although TB/HIV co-infection rates in this age group are lower.
虽然老年是发生活动性结核病（TB）的已知危险因素，但针对 60 岁及以上人群（本研究中视为老年人）的 TB 研究很少，特别是在发展中国家。乌干达 TB 患病率调查结果显示，65 岁以上人群的 TB 患病率较高（570/100,000）。我们专注于老年人的治疗结果，以更好地了解这一流行情况。我们对坎帕拉市 TB 机构登记册 2014-2015 年的数据进行了回顾性分析。我们根据年龄、性别、疾病类型、患者人类免疫缺陷病毒（HIV）和直接观察治疗（DOT）状况、机构类型以及治疗结果分析了 2014-2015 年的队列，并比较了老年人（≥60 岁）和年轻组（<60 岁）的结果。在 15429 份记录中，有 3.3%（514/15429）是老年人的记录。老年 TB 患者的治疗成功率（TSR）（68.3%）低于非老年人（80.9%）和坎帕拉整体 TSR（80.5%，12417/15429）。尽管老年人 HIV 检测阳性的可能性低于年轻人（AOR 0.39；95%CI 0.33-0.48，p<0.001），但他们的不良治疗结果风险高两倍（AOR 2.14；CI 1.84-2.72，p<0.001），在治疗期间死亡的风险更高（AOR 1.86；CI 1.27-2.73；p = 0.001）。然而，HIV 阳性和 HIV 阴性老年 TB 患者之间的治疗结果没有统计学上的显著差异。与年轻的 TB 患者相比，老年 TB 患者的治疗结果明显较差，尽管该年龄组的 TB/HIV 合并感染率较低。
