Department of Public Health Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia.
Bahagian Pengurusan Latihan Kementerian Kesihatan Malaysia, Putrajaya, Malaysia.
BMJ Open. 2024 Feb 26;14(2):e080144. doi: 10.1136/bmjopen-2023-080144.
Due to the paucity of literature on risk factors for tuberculosis (TB)-related death, we determine the sociodemographic and clinical risk factors associated with TB-related deaths among adult pulmonary TB (PTB) patients on treatment in Selangor, Malaysia.
Retrospective cohort study.
Routinely collected primary care data from all government TB clinics in Selangor.
Data of 24 570 eligible adult PTB patients from 2013 to 2019 were obtained from Selangor's State Health Department surveillance records. We included PTB patients aged at least 15 years old at the time of diagnosis with complete documentation of the dates of diagnosis, treatment initiation, end of treatment/follow-up and treatment outcomes. We excluded patients whose diagnoses were changed to non-TB, post-mortem TB diagnosis and multidrug-resistant TB (MDR-TB) patients.
TB-related death, determined from the recorded physicians' consensus during the TB mortality meeting.
TB-related death was significantly associated with far (adjusted HR (aHR) 9.98, 95% CI 4.28 to 23.28) and moderately advanced (aHR 3.23, 95% CI 1.43 to 7.31) radiological findings at diagnosis; concurrent TB meningitis (aHR 7.67, 95% CI 4.53 to 12.98) and miliary TB (aHR 6.32, 95% CI 4.10 to 9.74) involvement; HIV positive at diagnosis (aHR 2.81, 95% CI 2.21 to 3.57); Hulu Selangor (aHR 1.95, 95% CI 1.29 to 2.93), Klang (aHR 1.53, 95% CI 1.18 to 1.98) and Hulu Langat (aHR 1.31, 95% CI 1.03 to 1.68) residing districts; no formal education (aHR 1.70, 95% CI 1.23 to 2.35); unemployment (aHR 1.54, 95% CI 1.29 to 1.84), positive sputum smear acid-fast bacilli (AFB) at diagnosis (aHR 1.51, 95% CI 1.22 to 1.85); rural residency (aHR 1.39, 95% CI 1.13 to 1.72) and advancing age (aHR 1.03, 95% CI 1.02 to 1.03).
Far and moderately advanced radiological findings, concurrent TB meningitis and miliary TB involvement, HIV positive, Hulu Selangor, Klang and Hulu Langat residing districts, no formal education, unemployment, positive sputum smear AFB, rural residency and advancing age are risk factors of TB-related death. Our findings should assist in identifying high-risk patients requiring interventions against TB-related death.
由于有关结核病（TB）相关死亡危险因素的文献很少，因此我们确定了与在马来西亚雪兰莪州接受治疗的成人肺结核（PTB）患者相关的与 TB 相关的死亡的社会人口学和临床危险因素。
回顾性队列研究。
雪兰莪州所有政府结核病诊所的常规收集的初级保健数据。
从雪兰莪州州卫生部门的监测记录中获得了 2013 年至 2019 年 24570 名符合条件的成年 PTB 患者的数据。我们纳入了至少在诊断时年满 15 岁的 PTB 患者，并且完整记录了诊断日期、治疗开始日期、治疗结束/随访日期和治疗结果。我们排除了那些诊断被更改为非结核病、死后结核病诊断和耐多药结核病（MDR-TB）患者的患者。
TB 相关死亡，根据 TB 死亡率会议期间记录的医生共识来确定。
TB 相关死亡与远处（调整后的 HR（aHR）9.98，95%CI 4.28 至 23.28）和中度晚期（aHR 3.23，95%CI 1.43 至 7.31）放射学发现；并发结核性脑膜炎（aHR 7.67，95%CI 4.53 至 12.98）和粟粒性结核病（aHR 6.32，95%CI 4.10 至 9.74）；诊断时 HIV 阳性（aHR 2.81，95%CI 2.21 至 3.57）；雪兰莪州 Hulu（aHR 1.95，95%CI 1.29 至 2.93）、巴生（aHR 1.53，95%CI 1.18 至 1.98）和乌鲁冷岳（aHR 1.31，95%CI 1.03 至 1.68）的居住地区；没有接受过正规教育（aHR 1.70，95%CI 1.23 至 2.35）；失业（aHR 1.54，95%CI 1.29 至 1.84），诊断时痰涂片抗酸杆菌（AFB）阳性（aHR 1.51，95%CI 1.22 至 1.85）；农村居住（aHR 1.39，95%CI 1.13 至 1.72）和年龄增长（aHR 1.03，95%CI 1.02 至 1.03）。
远处和中度晚期影像学表现、并发结核性脑膜炎和粟粒性结核病、HIV 阳性、雪兰莪州 Hulu、巴生和乌鲁冷岳的居住地区、未接受过正规教育、失业、痰涂片 AFB 阳性、农村居住和年龄增长是与 TB 相关死亡相关的危险因素。我们的研究结果应该有助于识别需要干预以预防 TB 相关死亡的高危患者。
