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Risk factors for death during tuberculosis treatment in Orel, Russia
P K Dewan1, P M Arguin, H Kiryanova
1Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. puneet.dewan@sfdph.org
Setting And Methods:
In Orel, high tuberculosis (TB) case fatality rates have persisted despite successful implementation of the World Health Organization (WHO) global TB control strategy. We conducted a case control study to identify risk factors for mortality among Orel TB patients reported from October 1999 through June 2001. Cases were patients who died within 8 months of treatment initiation. We analyzed data abstracted from medical records using conditional logistic regression.
Results:
Over the 21-month period, 63/1069 (5.9%) TB patients overall and 45/521 (8.6%) sputum smear-positive patients died during treatment. Compared to 192 controls, independent risk factors for death for both smear-positive and smear-negative patients included unemployment (adjusted odds ratio [AOR] 4.9, 95% confidence interval [CI] 1.9-12.9), homelessness (AOR 9.5, 95% CI 1.3-70.9), congestive heart failure (AOR 5.4, 95% CI 1.9-15.9), chronic lung disease (AOR 2.4, 95% CI 1.1-5.4), cancer (AOR 7.2, 95% CI 1.2-45.0), bilateral disease on chest X-ray (AOR 6.3, 95% CI 2.3-17.1), and hyperbilirubinemia (AOR 5.2, 95% CI 1.1-25.3). Among deaths, the median time from treatment initiation to death was 35 days.
Conclusions:
The diagnosis and treatment of TB in suspects with the observed comorbidities and risk factors should be aggressively pursued. The association of unemployment and homelessness with mortality suggests a contribution of poverty to death during TB treatment.
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