Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland.
Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland.
BMC Public Health. 2020 Aug 17;20(1):1250. doi: 10.1186/s12889-020-09360-7.
Major transition in tuberculosis (TB) epidemiology is taking place in many European countries including Finland. Monitoring treatment outcome of TB cases is important for identifying gaps in the national TB control program, in order to strengthen the system. The aim of the study was to identify potential risk factors for non-successful TB treatment outcomes, with a particular focus on the impact of comorbidities. We also evaluated the treatment outcome monitoring system.
All notified microbiologically confirmed pulmonary TB cases in Finland in 2007-2014 were included, except multi-drug resistant (MDR) cases. Nationwide register data were retrieved from: Infectious Diseases Register, Population Register, Cause of Death Register and Hospital Discharge Register. Non-successful outcomes were divided into three groups: death, unsatisfactory outcomes and non-defined outcomes. Logistic regression analyses were used to identify risk factors for non-successful outcomes.
Treatment outcomes were notified for 98.6% of study cases (n = 1396/1416). Treatment success rate was 75%. The main reason for non-successful outcome was death (16%), whereas outcomes failed and lost to follow-up were rare (1% together). In a multivariable model, risk factors for death as outcome were increasing age, male gender and Charlson comorbidity index ≥1, for unsatisfactory outcomes non-MDR drug resistance and TB registered in the first study period, and for non-defined outcomes non-MDR drug resistance. Among 50 cases with unsatisfactory outcomes, we observed false outcome allocations in eight (16%), and > 2% of the cases transferred to another country or disappeared before or during treatment.
With a high proportion of older population among tuberculosis cases, death is a common treatment outcome in Finland. Comorbidity is an important factor to be incorporated when interpreting and comparing outcome rates. There was a considerable inconsistency in outcome allocation in the monitoring system, which implies that there is need to review the guidelines and provide further training for outcome assessment.
结核病（TB）流行病学在许多欧洲国家包括芬兰正在发生重大转变。监测结核病病例的治疗结果对于确定国家结核病控制计划中的差距至关重要，以便加强该系统。本研究的目的是确定治疗失败的潜在风险因素，特别是关注合并症的影响。我们还评估了治疗结果监测系统。
纳入 2007-2014 年芬兰所有经微生物学证实的肺部结核病病例，但不包括耐多药（MDR）病例。从传染病登记处、人口登记处、死因登记处和住院病人出院记录中检索全国性登记数据。将治疗结果分为三组：死亡、结果不佳和未定义的结果。采用逻辑回归分析确定治疗失败的风险因素。
通知了研究病例的 98.6%（n=1396/1416）的治疗结果。治疗成功率为 75%。非成功结果的主要原因是死亡（16%），而治疗失败和失访的结果很少（1%）。在多变量模型中，死亡的风险因素是年龄增长、男性性别和 Charlson 合并症指数≥1，对于结果不佳的风险因素是非 MDR 耐药和在第一个研究期间登记的结核病，对于未定义的结果是非 MDR 耐药。在 50 例结果不佳的病例中，我们观察到 8 例（16%）结果分配错误，在治疗前或治疗期间有>2%的病例转移到另一个国家或失踪。
由于结核病病例中有相当比例的老年人，死亡是芬兰的常见治疗结果。在解释和比较结果率时，合并症是一个重要的因素。监测系统中结果分配存在相当大的不一致性，这意味着需要审查指南并为结果评估提供进一步培训。
