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Predictors of death from pulmonary tuberculosis: the case of Veracruz, Mexico
L P Bustamante-Montes1, A Escobar-Mesa, V H Borja-Aburto
1Instituto Nacional de Salud Pública, Cuernavaca, Universidad Autónoma del Estada de México, Facultad de Medicina, Toluca. patyb@toluca.podernet.com.mx
Objectives:
To identify factors (particularly social, economic and cultural), associated with the risk of death from pulmonary tuberculosis in Mexico.
Methods:
A case-control study of patients receiving medical attention from the official health services of Veracruz, Mexico. Cases were deaths from pulmonary tuberculosis in 1993. Controls were survivors randomly selected from the State Tuberculosis Case Registry. Next of kin provided information for both cases and controls.
Results:
Multivariate analysis of 161 cases and 161 controls showed an increased risk of dying for those patients who withdrew from treatment (odds ratio [OR] = 3.52), who were refused medical attention during some period of time in any health center (OR = 4.45), and who had a concomitant disease at the time of diagnosis (OR = 2.62). A linear trend with age was observed (OR = 1.02 per year), as well as a lower risk for those patients who were compliant with treatment and optimistic about surviving the disease (OR = 0.17). The risk of death was not associated with the presence of a health care unit in the town, time spent to get to the health center, or the residence of a patient in an urban area.
Conclusions:
These findings indicate that deaths due to tuberculosis in this area are not related to the geographical distribution of health services but to delays in treatment after the onset of disease and to the low adherence of patients to the treatment regimen.