J Shuldiner1, A Leventhal1, D Chemtob2, Z Mor2. 1. <label>*</label>Hadassah School of Public Health and Community Medicine, Braun Hebrew University, Jerusalem. 2. <label><sup>‡</sup></label>Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem.
Abstract
SETTING: Tuberculosis (TB) epidemiology in Israel is similar to that reported from other industrialised countries where most patients are foreign-born. OBJECTIVES: To assess TB case fatality rate (CFR) and mortality trends during treatment and to identify risk factors associated with mortality. DESIGN: Retrospective cohort study of all TB patients in Israel diagnosed between 2000 and 2010. Cause of death was classified by TB-specific and non-TB-specific causes. RESULTS: During the study period, 451 TB patients died during treatment, representing a CFR of 9.9%. Of these, 72.5% died due to TB-related causes, giving a TB-related CFR of 7.2%. Both the overall and TB-related CFR decreased over the study period. Risk factors for death included male sex, older age, human immunodeficiency virus coinfection, culture positivity and multidrug-resistant TB (MDR-TB). Patients aged ≥65 years comprised 70% of the TB-related deaths, and more than half of these (54.9%) were born in the former Soviet Union, Europe (excluding the former Soviet Union) or the USA. CONCLUSION: Both the overall and TB-related CFR decreased over the study period. Physicians who treat older male TB patients with MDR-TB or HIV should increase the index of suspicion to include the possibility of a higher risk of mortality.
SETTING:Tuberculosis (TB) epidemiology in Israel is similar to that reported from other industrialised countries where most patients are foreign-born. OBJECTIVES: To assess TB case fatality rate (CFR) and mortality trends during treatment and to identify risk factors associated with mortality. DESIGN: Retrospective cohort study of all TB patients in Israel diagnosed between 2000 and 2010. Cause of death was classified by TB-specific and non-TB-specific causes. RESULTS: During the study period, 451 TB patients died during treatment, representing a CFR of 9.9%. Of these, 72.5% died due to TB-related causes, giving a TB-related CFR of 7.2%. Both the overall and TB-related CFR decreased over the study period. Risk factors for death included male sex, older age, human immunodeficiency virus coinfection, culture positivity and multidrug-resistant TB (MDR-TB). Patients aged ≥65 years comprised 70% of the TB-related deaths, and more than half of these (54.9%) were born in the former Soviet Union, Europe (excluding the former Soviet Union) or the USA. CONCLUSION: Both the overall and TB-related CFR decreased over the study period. Physicians who treat older male TB patients with MDR-TB or HIV should increase the index of suspicion to include the possibility of a higher risk of mortality.
Authors: Alberto L García-Basteiro; Durval Respeito; Orvalho J Augusto; Elisa López-Varela; Charfudin Sacoor; Victor G Sequera; Aina Casellas; Quique Bassat; Ivan Manhiça; Eusebio Macete; Frank Cobelens; Pedro L Alonso Journal: BMC Infect Dis Date: 2016-05-20 Impact factor: 3.090