移民人口结核病治疗结局失败风险高：来自意大利三家医院的数据。

High risk of unsuccessful treatment outcome in migrant population with tuberculosis: Data from three Italian hospitals.

机构信息

Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro," Bari, Italy.

Unità Operativa Complessa (UOC) Infectious Diseases Azienda Sanitaria Locale Bari (ASL BA), Bari, Italy.

出版信息

Front Public Health. 2023 Jan 10;10:1024474. doi: 10.3389/fpubh.2022.1024474. eCollection 2022.

DOI:10.3389/fpubh.2022.1024474

PMID:36703820

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9871451/

Abstract

INTRODUCTION

Tuberculosis (TB) remains an unresolved global health problem and vulnerable groups such as migrants remain the most affected with a higher risk of worse outcomes. The aim of this study was to evaluate clinical features, outcomes, and adverse events in migrant and native Italian patients admitted to three Italian hospitals in Southern Italy in order to assess differences and targeted strategies.

METHODS

We performed a retrospective study on TB patients admitted between January 1, 2013, and December 31, 2021, in three Apulia hospitals. Two logistic regression models were used, with the dependent variables being (I) unsuccessful treatment (died, loss to follow-up, and failed treatment) and (II) adverse events.

RESULTS

We enrolled 543 consecutive patients admitted at three Italian hospitals with a diagnosis of TB during the study period, of them 323 (59.5%) were migrants and 220 Italian patients. The treatment success rate in the migrant group was 44.9% (137/305), while in the non-migrant group was 97.1% (203/209). Independent factors of unsuccess treatment (death, failure or loss to follow up) were: migrant status (O.R. = 11.31; 95% CI 9.72-14.23), being male (O.R. = 4.63; 95% CI 2.16-6.10), homelessness (O.R. = 3.23; 95% CI 2.58-4.54), having a MDR (Multidrug-resistant) (O.R = 6.44; 95% CI 4.74-8.23), diagnostic delay (O.R. = 3.55; 95% CI 1.98-5.67), and length of hospitalization (O.R. = 3.43; 95% CI 1.88-5.87). While, age >65 ys (O.R. = 3.11; 95% CI 1.42-4.76), presence of extrapulmonary TB (O.R. = 1.51; 95% CI 1.31-2.18), monoresistance (O.R. = 1.45; 95% CI 1.25-3.14) and MDR pattern (O.R. = 2.44; 95% CI 1.74-5.03) resulted associated with adverse events.

CONCLUSION

Migrant population is at high risk of unsuccessful treatment (death, loss to follow-up, and treatment failure). Policies targeted specifically to this group are needed to really impact and improve their health status and also to contain the TB burden.

摘要

简介

结核病（TB）仍然是一个未解决的全球健康问题，移民等弱势群体仍然是受影响最严重的群体，他们的预后更差。本研究旨在评估 2013 年 1 月 1 日至 2021 年 12 月 31 日期间在意大利南部三家意大利医院住院的移民和意大利本土患者的临床特征、结局和不良事件，以评估差异和针对性策略。

方法

我们对 2013 年 1 月 1 日至 2021 年 12 月 31 日期间在意大利普利亚大区三家医院住院的结核患者进行了回顾性研究。使用了两个逻辑回归模型，因变量为（I）治疗失败（死亡、失访和治疗失败）和（II）不良事件。

结果

我们共纳入了在研究期间在三家意大利医院确诊为结核病的 543 例连续患者，其中 323 例（59.5%）为移民，220 例为意大利患者。移民组的治疗成功率为 44.9%（137/305），而非移民组为 97.1%（203/209）。治疗失败（死亡、失败或失访）的独立因素包括：移民身份（OR=11.31；95%CI 9.72-14.23）、男性（OR=4.63；95%CI 2.16-6.10）、无家可归（OR=3.23；95%CI 2.58-4.54）、耐多药（MDR）（OR=6.44；95%CI 4.74-8.23）、诊断延迟（OR=3.55；95%CI 1.98-5.67）和住院时间（OR=3.43；95%CI 1.88-5.87）。而年龄>65 岁（OR=3.11；95%CI 1.42-4.76）、存在肺外结核（OR=1.51；95%CI 1.31-2.18）、单耐药（OR=1.45；95%CI 1.25-3.14）和 MDR 模式（OR=2.44；95%CI 1.74-5.03）与不良事件相关。