Geleso Mulugeta Geremew
Department of Statistics, Wolkite University, Wolkite, Ethiopia.
Risk Manag Healthc Policy. 2020 May 25;13:473-481. doi: 10.2147/RMHP.S251376. eCollection 2020.
Tuberculosis (TB) is still a public health problem and amongst the top ten leading causes of death. The aim of this paper was to identify the factors that significantly affect the survival of tuberculosis patients.
A retrospective cohort study was carried out in Adigrat General and Wukro hospitals, Eastern Zone of Tigray region, Ethiopia. Data for this study were obtained from medical records of all TB cases registered from September 2016 to August 2017 in the two hospitals. Log-rank test and Kaplan-Meier plot were used to evaluate the survival pattern of TB patients. A multivariable Cox proportional regression model was employed to identify the predictors of mortality. Factors with a -value smaller than 0.05 were taken as statistically significant facilitators of TB death.
Of the 397 patients studied over the specified period, 23 (5.8%) had died. A statistically significant survival difference was observed among gender, residence, HIV status, treatment category, and age category of patients. In multivariable cox regression, lower survival rates were observed among patients aged ≥45 years (HR = 5.315, 95% CI: 1.231-22.959), relapse cases (HR = 4.069, 95% CI: 1.636-10.119), patients with extrapulmonary TB (HR = 3.054, 95% CI: 1.044-8.940), patients from rural areas (HR = 2.834, 95% CI: 1.161-6.916), patients with a bodyweight of ≤50 kg and HIV-positive patients.
Based on the survival experience of TB patients, advancing age, extrapulmonary TB infection, living in rural residence, lower bodyweight at beginning of treatment, HIV co-infection, and being a retreatment patient were predictors of mortality. To achieve the "End TB Strategy" goal of zero death, proper targeting of care to these vulnerable groups should be advised.
结核病仍是一个公共卫生问题，位列十大主要死因之中。本文旨在确定显著影响结核病患者生存的因素。
在埃塞俄比亚提格雷地区东部区的阿迪格拉特综合医院和武克罗医院开展了一项回顾性队列研究。本研究的数据取自2016年9月至2017年8月在这两家医院登记的所有结核病病例的医疗记录。采用对数秩检验和Kaplan-Meier曲线来评估结核病患者的生存模式。运用多变量Cox比例回归模型来确定死亡率的预测因素。P值小于0.05的因素被视为结核病死亡的统计学显著促成因素。
在指定时期内研究的397例患者中，有23例（5.8%）死亡。在患者的性别、居住地、艾滋病毒感染状况、治疗类别和年龄类别之间观察到了具有统计学意义 的生存差异。在多变量Cox回归中，年龄≥45岁的患者（风险比=5.315，95%置信区间：1.231 - 22.959）、复发病例（风险比=4.069，95%置信区间：1.636 - 10.119）、肺外结核患者（风险比=3.054，95%置信区间：1.044 - 8.940）、农村地区患者（风险比=2.834，95%置信区间：1.161 - 6.916）、体重≤50 kg的患者以及艾滋病毒阳性患者的生存率较低。
基于结核病患者的生存经验，高龄、肺外结核感染、居住在农村、治疗开始时体重较低、艾滋病毒合并感染以及复治患者是死亡率的预测因素。为实现“终止结核病战略”零死亡的目标，建议针对这些弱势群体进行适当的护理。
