Desmond Tutu Tuberculosis Centre, Departments of Paediatrics and Child Health and
Desmond Tutu Tuberculosis Centre, Departments of Paediatrics and Child Health and.
Pediatrics. 2021 Apr;147(4). doi: 10.1542/peds.2020-032490. Epub 2021 Mar 10.
In South Africa, tuberculosis (TB) is a leading cause of death among those <20 years of age. We describe changes in TB mortality among children and adolescents in South Africa over a 13-year period, identify risk factors for mortality, and estimate excess TB-related mortality.
Retrospective analysis of all patients <20 years of age routinely recorded in the national electronic drug-susceptible TB treatment register (2004-2016). We developed a multivariable Cox regression model for predictors of mortality and used estimates of mortality among the general population to calculate standardized mortality ratios (SMRs).
Between 2004 and 2016, 729 463 children and adolescents were recorded on TB treatment; 84.0% had treatment outcomes and 2.5% (18 539) died during TB treatment. The case fatality ratio decreased from 3.3% in 2007 to 1.9% in 2016. In the multivariable Cox regression model, ages 0 to 4, 10 to 14, and 15 to 19 years (compared with ages 5 to 9 years) were associated with increased risk of mortality, as was HIV infection, previous TB treatment, and extrapulmonary involvement. The SMR of 15 to 19-year-old female patients was more than double that of male patients the same age (55.3 vs 26.2). Among 10 to 14-year-olds and those who were HIV-positive, SMRs increased over time.
Mortality in South African children and adolescents treated for TB is declining but remains considerable, with 2% dying during 2016. Adolescents (10 to 19 years) and those people living with HIV have the highest risk of mortality and the greatest SMRs. Interventions to reduce mortality during TB treatment, specifically targeting those at highest risk, are urgently needed.
在南非，结核病（TB）是 20 岁以下人群的主要死亡原因。我们描述了南非在 13 年内儿童和青少年结核病死亡率的变化，确定了死亡的危险因素，并估计了与结核病相关的超额死亡人数。
对全国电子药物敏感结核病治疗登记册（2004-2016 年）中常规记录的所有 20 岁以下患者进行回顾性分析。我们为死亡率的预测因素开发了一个多变量 Cox 回归模型，并使用一般人群的死亡率估计值来计算标准化死亡率比（SMR）。
2004 年至 2016 年间，有 729463 名儿童和青少年接受了结核病治疗；84.0%的患者有治疗结果，2.5%（18539 人）在结核病治疗期间死亡。病死率从 2007 年的 3.3%下降到 2016 年的 1.9%。在多变量 Cox 回归模型中，0 至 4 岁、10 至 14 岁和 15 至 19 岁（与 5 至 9 岁相比）与死亡率增加相关，艾滋病毒感染、以前的结核病治疗和肺外受累也是如此。15 至 19 岁女性患者的 SMR 是同龄男性患者的两倍多（55.3 比 26.2）。在 10 至 14 岁和 HIV 阳性患者中，SMR 随时间增加。
在南非接受结核病治疗的儿童和青少年的死亡率正在下降，但仍然相当高，2016 年有 2%的患者死亡。青少年（10 至 19 岁）和艾滋病毒感染者的死亡率和 SMR 最高。迫切需要采取干预措施来降低结核病治疗期间的死亡率，特别是针对高危人群。
