Department of Social and Preventive Medicine, Centre for Epidemiology and Evidence-Based Practice, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Bandar Setia Alam, Shah Alam, Selangor, Malaysia.
PLoS One. 2020 Apr 22;15(4):e0231986. doi: 10.1371/journal.pone.0231986. eCollection 2020.
The monitoring of tuberculosis (TB) treatment outcomes and examination of the factors affecting these outcomes are important for evaluation and feedback of the national TB control program. This study aims to assess the TB treatment outcomes among patients registered in the national TB surveillance database in Malaysia from 2014 until 2017 and identify factors associated with unsuccessful treatment outcomes and all-cause mortality.
Using registry-based secondary data, a retrospective cohort study was conducted. TB patients' sociodemographic characteristics, clinical disease data and treatment outcomes at one-year surveillance were extracted from the database and analyzed. Logistic regression analysis was used to determine factors associated with unsuccessful treatment outcomes and all-cause mortality.
A total of 97,505 TB cases (64.3% males) were included in this study. TB treatment success (cases categorized as cured and completed treatment) was observed in 80.7% of the patients. Among the 19.3% patients with unsuccessful treatment outcomes, 10.2% died, 5.3% were lost to follow-up, 3.6% had outcomes not evaluated while the remaining failed treatment. Unsuccessful TB treatment outcomes were found to be associated with older age, males, foreign nationality, urban dwellers, lower education levels, passive detection of TB cases, absence of bacille Calmette-Guerin (BCG) scar, underlying diabetes mellitus, smoking, extrapulmonary TB, history of previous TB treatment, advanced chest radiography findings and human immunodeficiency virus (HIV) infection. Factors found associated with all-cause mortality were similar except for nationality (higher among Malaysians) and place of residence (higher among rural dwellers), while smoking and history of previous TB treatment were not found to be associated with all-cause mortality.
This study identified various sociodemographic characteristics and TB disease-related variables which were associated with unsuccessful TB treatment outcomes and mortality; these can be used to guide measures for risk assessment and stratification of TB patients in future.
监测结核病（TB）治疗结果并研究影响这些结果的因素，对于评估和反馈国家结核病控制规划非常重要。本研究旨在评估 2014 年至 2017 年期间在马来西亚国家结核病监测数据库中登记的患者的结核病治疗结果，并确定与治疗失败和全因死亡率相关的因素。
本研究使用基于登记的二级数据，开展了一项回顾性队列研究。从数据库中提取结核病患者的社会人口统计学特征、临床疾病数据和一年监测时的治疗结果，并进行分析。采用逻辑回归分析确定与治疗失败和全因死亡率相关的因素。
本研究共纳入 97505 例结核病病例（64.3%为男性）。80.7%的患者治疗成功（治愈和完成治疗的病例）。在 19.3%治疗失败的患者中，10.2%死亡，5.3%失访，3.6%未评估结局，其余患者治疗失败。治疗失败与年龄较大、男性、外国国籍、城市居民、教育程度较低、被动发现结核病病例、无卡介苗（BCG）疤痕、合并糖尿病、吸烟、肺外结核病、既往结核病治疗史、较严重的胸部影像学表现和人类免疫缺陷病毒（HIV）感染有关。与全因死亡率相关的因素除了国籍（马来西亚人较高）和居住地（农村居民较高）外，与治疗失败的因素相似，而吸烟和既往结核病治疗史与全因死亡率无关。
本研究确定了与治疗失败和死亡率相关的各种社会人口统计学特征和结核病疾病相关变量，可用于指导未来对结核病患者进行风险评估和分层的措施。
