Skouvig Pedersen Ole, Butova Tetiana, Miasoiedov Valerii, Feshchenko Yurii, Kuzhko Mykhailo, Niemann Stefan, Rosenthal Alex, Grinev Alina, Rosenfeld Gabriel, Hoppes Michael Drew, Kilmnick Julia, Crudu Valeriu, Ciobanu Nelly, Codreanu Alexandru, Toxanbayeva Bekzat, Chingissova Lyailya, Yurko Kateryna, Kucheriavchenko Valerii, Vekshyn Vitalii, Vashakidze Sergo, Shubladze Natalia, Avaliani Zaza, Kadyrov Abdullaat, Kalmambetova Gulmira, Sydykova Merbubu, Ghita Eugenia, Grecu Victor Ionel, Miulescu Alina Marinela, Wejse Christian Morberg, Fløe Andreas, Dahl Victor Naestholt, Butov Dmytro
Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.
Outpatient Department, Merefa Central District Hospital, Merefa, Ukraine.
Lancet Reg Health Eur. 2025 Jun 25;55:101354. doi: 10.1016/j.lanepe.2025.101354. eCollection 2025 Aug.
Addressing the disproportionate representation between sexes is essential for achieving universal health coverage. Studies on the association between sex and unsuccessful tuberculosis treatment outcomes have shown conflicting results. This study examines this association and analyses sex-stratified risk factors associated with unsuccessful outcomes.
This retrospective, observational cohort study analysed prospectively collected data from six Eastern European countries from 2020 to 2022. Treatment outcomes were defined using World Health Organization criteria. Uni- and multivariable logistic regression models were used to assess the association between sex and unsuccessful outcomes ('treatment failure', 'lost to follow-up', 'died', or any of these). After propensity score matching females and males, the multivariable analysis was repeated. Risk factors were analysed separately for each sex and compared using interaction terms.
Among females, 19·5% (n = 290/1490) (95% confidence interval [CI]: 18, 22) achieved an unsuccessful treatment outcome, compared with 30% (n = 1363/4553) (95% CI: 29, 31) among males. In the multivariable analyses, female sex was associated with 32% lower odds of any unsuccessful outcome (adjusted odds ratio [aOR] 0·68, 95% CI: 0·58, 0·80), 36% lower odds of dying (aOR 0·64, 95% CI: 0·51, 0·80), and 37% lower odds of treatment failure (aOR 0·63, 95% CI: 0·47, 0·85). The association between sex and being 'lost to follow-up' was not significant. In the propensity score-matched cohort, sex was not associated with unsuccessful outcomes. Risk factors for unsuccessful outcomes were similar for females and males, except that in females aged >65 years, the odds of death were 2·2 times higher (95% CI: 1·1, 4·4).
Male sex was associated with unsuccessful outcomes, including death and treatment failure, but adjusting for socio-demographic and clinical factors, and matching males to females, attenuated the association, suggesting that sex disparities in tuberculosis outcomes may be driven more by behavioural than biological factors. Longitudinal studies are needed to confirm these findings.
The publication fee was funded by the Civilian Research and Development Foundation (CRDF) under grant #G-202407-72538.
解决性别之间的不均衡代表情况对于实现全民健康覆盖至关重要。关于性别与结核病治疗未成功结局之间关联的研究结果相互矛盾。本研究考察这种关联，并分析与未成功结局相关的按性别分层的风险因素。
这项回顾性观察性队列研究分析了2020年至2022年从6个东欧国家前瞻性收集的数据。使用世界卫生组织标准定义治疗结局。单变量和多变量逻辑回归模型用于评估性别与未成功结局（“治疗失败”、“失访”、“死亡”或其中任何一种）之间的关联。在对女性和男性进行倾向得分匹配后，重复进行多变量分析。分别分析每种性别的风险因素，并使用交互项进行比较。
在女性中，19.5%（n = 290/1490）（95%置信区间[CI]：18，22）治疗结局未成功，而男性中这一比例为30%（n = 1363/4553）（95% CI：29，31）。在多变量分析中，女性性别与任何未成功结局的几率降低32%相关（调整后的优势比[aOR] 0.68，95% CI：0.58，0.80），死亡几率降低36%（aOR 0.64，95% CI：0.51，0.80），治疗失败几率降低37%（aOR 0.63，95% CI：0.47，0.85）。性别与“失访”之间的关联不显著。在倾向得分匹配队列中，性别与未成功结局无关。女性和男性未成功结局的风险因素相似，只是在65岁以上的女性中，死亡几率高2.2倍（95% CI：1.1，4.4）。
男性性别与包括死亡和治疗失败在内的未成功结局相关，但在调整社会人口学和临床因素并将男性与女性匹配后，这种关联减弱，这表明结核病结局中的性别差异可能更多地由行为因素而非生物学因素驱动。需要纵向研究来证实这些发现。
出版费用由民用研究与发展基金会（CRDF）根据资助编号#G - 202407 - 72538资助。
