Nordholm Anne Christine, Andersen Aase Bengaard, Wejse Christian, Norman Anders, Ekstrøm Claus Thorn, Andersen Peter Henrik, Lillebaek Troels, Koch Anders
International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.
Department of Infectious Diseases, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
Int J Infect Dis. 2023 May;130:76-82. doi: 10.1016/j.ijid.2023.02.024. Epub 2023 Mar 10.
This study aimed to analyze mortality, risk factors, and causes of death among people with tuberculosis (TB).
This is a population-based cohort study with patients with TB ≥18 years notified from 1990 to 2018 in Denmark, compared with sex- and age-matched controls. Mortality was assessed in Kaplan-Meier models and risk factors for death were estimated in Cox proportional hazards models.
Overall mortality was twofold higher among people with TB compared with controls up to 15 years after TB diagnosis (hazard ratio [HR]: 2.18, 95% confidence interval [CI]: 2.06-2.29, P <0.0001). Danes with TB were three times more likely to die than migrants (adjusted HR: 3.13, 95% CI: 2.84-3.45, P <0.0001). Risk factors for death included living alone, being unemployed, having low income, and comorbidities such as mental illness with substance abuse, lung diseases, hepatitis, and HIV. TB was the most common cause of death (21%), followed by chronic obstructive pulmonary disease (7%), lung cancer (6%), alcoholic liver disease (5%), and mental illness with substance abuse (4%).
People with TB had substantially inferior survival up to 15 years after TB diagnosis, in particular, socially disadvantaged Danes with TB with specific comorbidities. This may reflect unmet needs for enhanced treatment of other medical/social conditions during TB treatment.
本研究旨在分析结核病（TB）患者的死亡率、危险因素及死亡原因。
这是一项基于人群的队列研究，将1990年至2018年在丹麦通报的年龄≥18岁的结核病患者与性别和年龄匹配的对照组进行比较。采用Kaplan-Meier模型评估死亡率，用Cox比例风险模型估计死亡危险因素。
结核病诊断后长达15年，结核病患者的总体死亡率是对照组的两倍（风险比[HR]：2.18，95%置信区间[CI]：2.06 - 2.29，P<0.0001）。丹麦结核病患者死亡的可能性是移民的三倍（校正HR：3.13，95%CI：2.84 - 3.45，P<0.0001）。死亡危险因素包括独居、失业、低收入以及合并症，如伴有药物滥用的精神疾病、肺部疾病、肝炎和艾滋病毒。结核病是最常见的死亡原因（21%），其次是慢性阻塞性肺疾病（7%）、肺癌（6%）、酒精性肝病（5%）和伴有药物滥用的精神疾病（4%）。
结核病患者在结核病诊断后长达15年的生存率显著较低，尤其是社会处境不利且患有特定合并症结核病的丹麦人。这可能反映出结核病治疗期间对加强其他医疗/社会状况治疗的需求未得到满足。
