Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong, China.
Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
PLoS One. 2022 Jun 16;17(6):e0268290. doi: 10.1371/journal.pone.0268290. eCollection 2022.
Prevention of tuberculosis (TB) recurrence is an important issue in TB control. South Korea, a country with a high average income, has been challenged with an intermediate burden of TB. We aimed to estimate the TB recurrence rate after successful completion of the first anti-TB chemotherapy, and to identify the risk factors for the TB recurrence by focusing on co-morbidities and behavioral factors.
This is a population-based cohort study using data from the National Health Insurance (NHI) database between 2002 and 2013. Newly diagnosed TB patients were identified using the classification of disease codes and prescription records. Final analytical subjects included people who successfully completed the first anti-TB chemotherapy. The primary outcome measure was recurrent TB 6-month after the first treatment completion. A set of associated risk factors, including demographic characteristics, co-morbidities, and health behavior factors were analyzed using Cox regression analysis.
Among 5,446 TB patients, 2,226 (40.1%) completed the first anti-TB treatment. During the follow-up period, 150 (6.7%) patients had TB recurrence, and the crude recurrent rate was 22.6 per 1000 person-years. The majority of recurrence cases (89%) occurred within the first 2-year period. The major findings show that participants who are male (adjusted HR (aHR) = 1.81, at a 95% CI, range: 1.11-2.94), older in age (aHR = 1.07, at a 95% CI, range: 1.00-1.14), have a lower income (aHR = 1.96, at a 95% CI, range: 1.10-3.48) and who are underweight (aHR = 1.92, at a 95% CI, range 1.15-3.20) were at higher risks for TB recurrence.
People who have risk factors for recurrent TB need to improve treatment compliance through more effective TB management, and follow-up observation for one or two years after the treatment completion.
预防结核病（TB）复发是结核病控制的一个重要问题。韩国是一个高收入国家，但结核病负担处于中等水平。我们旨在评估首次抗结核化疗成功后 TB 复发的发生率，并通过关注合并症和行为因素来确定 TB 复发的风险因素。
这是一项基于人群的队列研究，使用了 2002 年至 2013 年期间国家健康保险（NHI）数据库的数据。使用疾病分类代码和处方记录来确定新诊断的 TB 患者。最终分析对象包括成功完成首次抗结核化疗的患者。主要结局指标是首次治疗完成后 6 个月内的复发性 TB。使用 Cox 回归分析了一组相关的风险因素，包括人口统计学特征、合并症和健康行为因素。
在 5446 例 TB 患者中，有 2226 例（40.1%）完成了首次抗结核治疗。在随访期间，有 150 例（6.7%）患者发生了 TB 复发，粗复发率为每 1000 人年 22.6 例。大多数复发病例（89%）发生在最初的 2 年内。主要发现表明，男性（调整后的 HR（aHR）=1.81，95%CI 范围：1.11-2.94）、年龄较大（aHR=1.07，95%CI 范围：1.00-1.14）、收入较低（aHR=1.96，95%CI 范围：1.10-3.48）和体重不足（aHR=1.92，95%CI 范围：1.15-3.20）的参与者复发 TB 的风险更高。
有复发性 TB 风险因素的人需要通过更有效的 TB 管理来提高治疗依从性，并在治疗完成后一到两年内进行随访观察。
