Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Brownsville campus, Brownsville, TX, USA.
Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
Medicine (Baltimore). 2023 Oct 13;102(41):e35458. doi: 10.1097/MD.0000000000035458.
Older people are at high risk of developing and dying from pulmonary infections like tuberculosis (TB), but there are few studies among them, particularly in Hispanics. To address these gaps, we sought to identify host factors associated with TB and adverse treatment outcomes in older Hispanics by conducting a cross-sectional study of TB surveillance data from Tamaulipas, Mexico (2006-2013; n = 8381). Multivariable logistic regressions were assessed for older adults (OA ≥65 years) when compared to young (YA, 18-39 years) and middle-aged adults (40-64 years). We found that the OA had features associated with a less complicated TB (e.g., lower prevalence of extra-pulmonary TB and less likely to abandon treatment or have drug resistant TB), and yet, were more likely to die during TB treatment (adj-OR 3.9, 95% 2.5, 5.25). Among the OA, excess alcohol use and low body mass index increased their odds of death during TB treatment, while a higher number of reported contacts (social support) was protective. Diabetes was not associated with adverse outcomes in OA. Although older age is a predictor of death during TB disease, OA are not prioritized by the World Health Organization for latent TB infection screening and treatment during contact investigations. With safer, short-course latent TB infection treatment available, we propose the inclusion of OA as a high-risk group in latent TB management guidelines.
老年人患肺结核（TB）等肺部感染的风险很高，且死亡率也很高，但针对老年人，尤其是西班牙裔老年人的研究却很少。为了填补这些空白，我们对来自墨西哥塔毛利帕斯州（2006-2013 年）的结核病监测数据进行了一项横断面研究，旨在确定与老年西班牙裔人群中结核病相关的宿主因素和不良治疗结局。多变量逻辑回归分析了老年人（≥65 岁）与年轻人（18-39 岁）和中年人（40-64 岁）的比较。与年轻人和中年人相比，我们发现老年人具有与较不复杂的结核病相关的特征（例如，较少发生肺外结核病，不太可能放弃治疗或患有耐多药结核病），但在结核病治疗期间更有可能死亡（调整后的比值比 3.9，95%置信区间 2.5，5.25）。在老年人中，过度饮酒和低体重指数增加了他们在结核病治疗期间死亡的几率，而报告的接触者（社会支持）数量越多则越能起到保护作用。糖尿病与老年人的不良结局无关。尽管年龄是结核病死亡的预测因素，但世界卫生组织并未将老年人列为潜伏性结核病感染筛查和接触者调查期间治疗的重点人群。随着更安全、更短程的潜伏性结核病感染治疗方法的出现，我们建议将老年人纳入潜伏性结核病管理指南中的高危人群。
