Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston, 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.
Epidemiol Infect. 2024 May 13;152:e82. doi: 10.1017/S0950268824000669.
Pulmonary tuberculosis (PTB) elimination efforts must consider the global growth of the ageing population. Here we used TB surveillance data from Texas, United States (2008-2020; total = 10656) to identify unique characteristics and outcomes in older adults (OA, ≥65 years) with PTB, compared to young adults (YA, 18-39 years) or middle-aged adults (40-64 years). We found that the proportion of OA with PTB increased from 15% in 2008 to 24% in 2020 (trend < 0.05). Diabetes was highly prevalent in OA (32%) but not associated with adverse outcomes. Death was 13-fold higher in OA compared to YA and was 7% at the time of diagnosis which suggests diagnostic delays. However, once TB was suspected, we found no differences in culture, smear, or nucleic acid detection of mycobacteria (although less lung cavitations) in OA. During treatment, OA had less drug-resistant TB, few adverse reactions and adhered with TB treatment. We recommend training healthcare workers to 'think TB' in OA, for prompt treatment initiation to diminish deaths. Furthermore, OA should be added as a priority group to the latent TB treatment guidelines by the World Health Organization, to prevent TB disease in this highly vulnerable group.
肺结核（PTB）消除工作必须考虑到全球人口老龄化的增长。在这里，我们使用了美国德克萨斯州的结核病监测数据（2008-2020 年；总计 10656 人），以确定老年患者（≥65 岁）与年轻患者（18-39 岁）或中年患者（40-64 岁）相比，PTB 的独特特征和结局。我们发现，老年患者中 PTB 的比例从 2008 年的 15%增加到 2020 年的 24%（趋势<0.05）。糖尿病在老年患者中患病率很高（32%），但与不良结局无关。与年轻患者相比，老年患者的死亡率高 13 倍，且在诊断时就有 7%的死亡率，这表明存在诊断延迟。然而，一旦怀疑患有结核病，我们发现老年患者的培养物、涂片或分枝杆菌核酸检测（尽管肺部空洞较少）没有差异。在治疗期间，老年患者的耐药性结核病较少，不良反应较少，且坚持结核病治疗。我们建议培训医疗保健工作者在老年患者中“考虑结核病”，以便及时开始治疗，减少死亡。此外，世界卫生组织应将老年患者纳入潜伏性结核病治疗指南的优先群体，以预防这一高风险群体发生结核病。
