Department of Statistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia.
Department of Statistics, College of Natural and Computational Science, Addis Ababa University, Addis Ababa, Ethiopia.
J Racial Ethn Health Disparities. 2023 Aug;10(4):1616-1628. doi: 10.1007/s40615-022-01348-w. Epub 2022 Jun 13.
Tuberculosis is a serious health threat, particularly for people living with human immunodeficiency virus (HIV), and HIV-positive people are more likely than others to contract the disease. Globally, tuberculosis (TB) is one of the leading causes of death among people living with HIV. The purpose of the current study was to identify factors associated with survival rates of TB/HIV co-infected patients using survival models.
A retrospective study was conducted on TB/HIV co-infected adult patients registered and under follow-up at Tepi General Hospital (TGH) and Mizan-Tepi University Teaching Hospital (MTUTH), southwest Ethiopia. All TB/HIV co-infection patients who were registered and under follow-up from 1st January 2015 through 1st January 2020 were considered. The global Schoenfeld test was used to test the proportional hazard (PH) assumption. Various accelerated failure time (AFT) models were compared to determine the best model for the time to death of TB/HIV co-infected patients' data set. Among the most commonly used accelerated failure time models (AFT models), the study used exponential, Weibull, log-logistic, and log-lognormal AFT models. AIC and BIC were used to compare the performance of fitted models. The data were analyzed with the statistical software R.
Of 363 TB/HIV co-infected patients followed for 60 months, 79 (21.8%) died, while the remaining 284 (78.2%) were censored. The overall median survival time was 15.6 months. The proportional hazard assumption was checked and it was violated. In comparison to other models, the lognormal AFT model performed better. The results of the multivariable lognormal AFT model showed that age, residence, substance use, educational status, clinical stages of the disease, cluster of differentiation 4 (CD4 count/mm), functional status, cotrimoxazole prophylactic therapy use (CPT use), and INH were all found to be significant factors, while gender, illness other than TB, and disclosure of status were insignificant variables at 5% level of significance.
Current study results revealed that older age, substance use, advanced WHO clinical stages of the disease (stage IV), bedridden functional status, and CD4 less than 200 count/mm were significantly associated with shorter survival time to death of HIV/TB co-infected patients while having advanced educational status, being from urban residence, CPT use, and INH significantly increase the survival time to death of TB/HIV co-infected patients. Patients with TB/HIV co-infection should be given special attention based on these important factors to improve their health and prolong their lives. HIV-positive patients are more likely than others to contract the TB disease. The risk of death among TB/HIV co-infected patients was found to be high. Out of all patients, 79 (21.8%) died. Accelerated failure time models are good alternatives for scenario Cox proportional hazard assumptions not met.
结核病是一个严重的健康威胁，尤其是对人类免疫缺陷病毒（HIV）感染者而言，HIV 阳性者比其他人更容易感染这种疾病。在全球范围内，结核病（TB）是 HIV 感染者死亡的主要原因之一。本研究的目的是使用生存模型来确定与 TB/HIV 合并感染患者生存率相关的因素。
对埃塞俄比亚西南部的 Tepi 综合医院（TGH）和 Mizan-Tepi 大学教学医院（MTUTH）登记并接受随访的 TB/HIV 合并感染成年患者进行回顾性研究。所有在 2015 年 1 月 1 日至 2020 年 1 月 1 日期间登记并接受随访的 TB/HIV 合并感染者均被纳入研究。采用全球 Schoenfeld 检验来检验比例风险（PH）假设。比较了各种加速失效时间（AFT）模型，以确定用于 TB/HIV 合并感染患者数据集的死亡时间的最佳模型。在最常用的加速失效时间模型（AFT 模型）中，研究使用了指数、威布尔、对数逻辑和对数正态 AFT 模型。AIC 和 BIC 用于比较拟合模型的性能。数据使用 R 统计软件进行分析。
在接受 60 个月随访的 363 例 TB/HIV 合并感染者中，有 79 例（21.8%）死亡，其余 284 例（78.2%）被删失。总的中位生存时间为 15.6 个月。检查了比例风险假设，发现该假设被违反。与其他模型相比，对数正态 AFT 模型表现更好。多变量对数正态 AFT 模型的结果表明，年龄、居住地、物质使用、教育状况、疾病的世卫组织临床阶段、分化簇 4（CD4 计数/mm）、功能状态、复方磺胺甲噁唑预防性治疗的使用（CPT 使用）和异烟肼均为显著因素，而性别、除结核病以外的疾病以及状态的披露则为无统计学意义的变量，在 5%的显著性水平上。
目前的研究结果表明，年龄较大、物质使用、晚期世卫组织疾病临床阶段（IV 期）、卧床不起的功能状态和 CD4 计数小于 200/mm 与 HIV/TB 合并感染者的死亡生存时间较短显著相关，而接受过高等教育、来自城市居住、CPT 使用和 INH 显著增加了 TB/HIV 合并感染者的死亡生存时间。应根据这些重要因素特别关注 TB/HIV 合并感染患者，以改善他们的健康状况并延长他们的生命。HIV 阳性者比其他人更容易感染结核病。TB/HIV 合并感染患者的死亡风险很高。在所有患者中，有 79 人（21.8%）死亡。加速失效时间模型是 Cox 比例风险假设未满足的替代方案。
