Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Department of Medicine, Harvard Medical School, Boston, MA, USA.
Can J Public Health. 2023 Apr;114(2):264-276. doi: 10.17269/s41997-022-00711-y. Epub 2022 Dec 2.
Multimorbidity is the presence of two or more chronic health conditions. Tuberculosis (TB) survivors are known to have higher prevalence of multimorbidity, although prevalence estimates from high-income low-TB incidence jurisdictions are not available and potential differences in the patterns of chronic disease among TB survivors with multimorbidity are poorly understood. In this study, we aimed to (1) compare the prevalence of multimorbidity among TB survivors with matched non-TB controls in a high-income setting; (2) assess the robustness of aim 1 analyses to different modelling strategies, unmeasured confounding, and misclassification bias; and (3) among people with multimorbidity, elucidate chronic disease patterns specific to TB survivors.
A population-based cohort study of people immigrating to British Columbia, Canada, 1985-2015, using health administrative data. Participants were divided into two groups: people diagnosed with TB (TB survivors) and people not diagnosed with TB (non-TB controls) in British Columbia. Coarsened exact matching (CEM) balanced demographic, immigration, and socioeconomic covariates between TB survivors and matched non-TB controls. Our primary outcome was multimorbidity, defined as ≥2 chronic diseases from the Elixhauser comorbidity index.
In the CEM-matched sample (n=1962 TB survivors; n=1962 non-TB controls), we estimated that 21.2% of TB survivors (n=416), compared with 12% of non-TB controls (n=236), had multimorbidity. In our primary analysis, we found a double-adjusted prevalence ratio of 1.74 (95% CI: 1.49-2.05) between TB survivors and matched non-TB controls for multimorbidity. Among people with multimorbidity, differences were observed in chronic disease frequencies between TB survivors and matched controls.
TB survivors had a 74% higher prevalence of multimorbidity compared with CEM-matched non-TB controls. TB-specific multimorbidity patterns were observed through differences in chronic disease frequencies between the matched samples. These findings suggest a need for TB-specific multimorbidity interventions in high-income settings such as Canada. We suggest TB survivorship as a framework for developing person-centred interventions for multimorbidity among TB survivors.
多种疾病是指存在两种或多种慢性健康状况。已知结核病（TB）幸存者的多种疾病患病率较高，尽管来自高收入、低结核病发病率司法管辖区的患病率估计数据尚不可用，而且对于多种疾病的 TB 幸存者中慢性疾病模式的潜在差异也知之甚少。在这项研究中，我们旨在：（1）在高收入环境中，比较 TB 幸存者与匹配的非 TB 对照者的多种疾病患病率；（2）评估目的 1 分析对于不同建模策略、未测量的混杂因素和分类偏倚的稳健性；（3）在患有多种疾病的人群中，阐明特定于 TB 幸存者的慢性疾病模式。
这是一项基于人群的队列研究，使用健康管理数据，对 1985 年至 2015 年间移民到不列颠哥伦比亚省的人群进行研究。参与者分为两组：在不列颠哥伦比亚省被诊断患有结核病（TB 幸存者）的人和未被诊断患有结核病（非 TB 对照组）的人。粗糙精确匹配（CEM）平衡了 TB 幸存者和匹配的非 TB 对照组之间的人口统计学、移民和社会经济协变量。我们的主要结局是多种疾病，定义为 Elixhauser 合并症指数中的≥2 种慢性疾病。
在 CEM 匹配的样本中（n=1962 例 TB 幸存者；n=1962 例非 TB 对照组），我们估计 21.2%的 TB 幸存者（n=416）患有多种疾病，而 12%的非 TB 对照组（n=236）患有多种疾病。在我们的主要分析中，我们发现 TB 幸存者与匹配的非 TB 对照组之间的多种疾病的双重调整患病率比为 1.74（95%CI：1.49-2.05）。在患有多种疾病的人群中，TB 幸存者和匹配对照组之间的慢性疾病频率存在差异。
与 CEM 匹配的非 TB 对照组相比，TB 幸存者的多种疾病患病率高 74%。通过匹配样本中慢性疾病频率的差异，观察到了特定于结核病的多种疾病模式。这些发现表明，在加拿大等高收入国家需要针对结核病的多种疾病干预措施。我们建议将结核病幸存者作为制定针对结核病幸存者多种疾病的以患者为中心的干预措施的框架。
