Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, 47000, Sungai Buloh, Selangor, Malaysia.
Biomedical Epidemiology Unit, Special Resource Centre, Institute for Medical Research (IMR), National institute of Health (NIH) Setia Alam, 40170, Shah Alam, Selangor, Malaysia.
BMC Public Health. 2022 Apr 1;22(1):638. doi: 10.1186/s12889-022-13020-3.
The increased risk of loss to follow-up among TB smokers raises concern over the secondary spread within the community. This study aimed to determine the factors associated with loss to follow-up among TB patients who smoke.
All registered TB patients who smoke in the state of Selangor between 2013 and 2017 via the Malaysian Tuberculosis Information System (MyTB) database were included for analysis. TB patients who smoke were considered those who are "current smoker" during the notification, while loss to follow-up was defined as a TB patient who had interrupted treatment for 2 months or longer. There were 3 main variable domains included for analysis: sociodemographic profiles, disease profiles, and comorbidities. Logistic regression analysis was used to identify determinants of loss to follow-up among TB patients who smoke.
A total of 14.1% (N = 813) of TB patients who smoke loss to follow-up. The determinants of loss to follow-up among TB smokers were working age population aged 32-41 and 42-53 years old (AOR 1.08; 95%CI 1.23,2.08) and (AOR 1.44; 95%CI 1.11,1.87) respectively, Malaysian nationality (AOR 2.34; 95%CI 1.66,3.30), patients staying in urban area (AOR 1.55; 95% CI 1.23,1.97), income level less than RM2160 (AOR 1.59; 95% CI 1.14,2.20), un-employed (AOR 1.30; 95%CI 1.09-1.55), have low education level i.e., secondary school education, primary school education and no formal education (AOR 1.60; 95%CI 1.22,2.10), (AOR 1.73; 95%CI 1.16,2.57) and (AOR 2.29; 95% CI 1.57,3.33) respectively, previously treated TB cases (AOR 2.19; 95% CI 1.71,2.81), active TB case detection methods (AOR 2.06; 95%CI 1.40,3.02), moderate lesion x-ray (AOR 1.60; 95%CI 1.13,2.27) and HIV positive (AOR 1.36; 95%CI 1.02,1.82). All the significant factors gave rise to the final model of determinants, with a predictability of 67.2% (95% CI 65.0,69.3).
The high proportion of loss to follow-up among TB patients who smoke highlight the importance of providing early risk detection that examines the three main domains of risk factors such as socioeconomic, disease profiles and comorbidities. Potential integrated intervention should aim to reduce the proportion of smoking among TB patients through the stop smoking programme together with directly observed therapy (DOT).
结核病患者中吸烟者的随访失访率增加，这引起了人们对结核病在社区内二次传播的担忧。本研究旨在确定与吸烟结核病患者随访失访相关的因素。
纳入 2013 年至 2017 年期间通过马来西亚结核病信息系统（MyTB）数据库登记的在雪兰莪州吸烟的所有结核病患者进行分析。在通报期间被视为“当前吸烟者”的结核病患者被认为是吸烟的结核病患者，而随访失访被定义为中断治疗 2 个月或更长时间的结核病患者。纳入了 3 个主要变量域进行分析：社会人口统计学特征、疾病特征和合并症。使用逻辑回归分析确定吸烟结核病患者随访失访的决定因素。
共有 14.1%（N=813）的吸烟结核病患者失访。吸烟结核病患者随访失访的决定因素是年龄在 32-41 岁和 42-53 岁的工作年龄人群（AOR 1.08；95%CI 1.23，2.08）和（AOR 1.44；95%CI 1.11，1.87），马来西亚国籍（AOR 2.34；95%CI 1.66，3.30），居住在城市地区的患者（AOR 1.55；95%CI 1.23，1.97），收入水平低于 2160 令吉（AOR 1.59；95%CI 1.14，2.20），失业（AOR 1.30；95%CI 1.09-1.55），受教育程度较低，即中学教育、小学教育和没有正规教育（AOR 1.60；95%CI 1.22，2.10），（AOR 1.73；95%CI 1.16，2.57）和（AOR 2.29；95%CI 1.57，3.33），既往结核病病例（AOR 2.19；95%CI 1.71，2.81），活动性结核病病例的检测方法（AOR 2.06；95%CI 1.40，3.02），中度病变 X 射线（AOR 1.60；95%CI 1.13，2.27）和 HIV 阳性（AOR 1.36；95%CI 1.02，1.82）。所有显著因素都导致了决定因素的最终模型，预测率为 67.2%（95%CI 65.0，69.3）。
吸烟结核病患者随访失访率较高，这凸显了提供早期风险检测的重要性，该检测应检查社会经济、疾病特征和合并症等三个主要风险因素领域。潜在的综合干预措施应旨在通过戒烟计划和直接观察治疗（DOT）减少结核病患者中的吸烟比例。
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