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Predictors and mortality associated with treatment default in pulmonary tuberculosis
1Department of Pulmonary Medicine, University of Tartu, Tartu, Estonia. kai.kliiman@kliinikum.ee
Summary
Socially disadvantaged patients, including those with alcohol abuse, unemployment, and multidrug-resistant tuberculosis (MDR-TB), are at higher risk of defaulting from tuberculosis treatment. Interventions should target these groups to improve treatment outcomes.
Area of Science:
- Public Health
- Infectious Diseases
- Epidemiology
Background:
- Tuberculosis (TB) remains a significant global health challenge, with treatment default contributing to disease progression and transmission.
- Identifying risk factors for treatment default is crucial for developing targeted interventions to improve TB control outcomes.
Purpose of the Study:
- To identify risk factors associated with defaulting from pulmonary tuberculosis (TB) treatment in Estonia.
- To assess the mortality rates and associated factors among patients who defaulted from TB treatment.
Main Methods:
- A retrospective cohort study was conducted on 1107 patients with culture-confirmed pulmonary TB who initiated treatment between 2003 and 2005.
- Statistical analyses, including logistic regression and Cox regression, were used to identify predictors of treatment default and mortality.
Main Results:
- The overall treatment success rate was 81.5%, with a default rate of 9.4%. For multidrug-resistant TB (MDR-TB), the success rate was 60.4% and default rate was 17.0%.
- Independent predictors of treatment default included alcohol abuse, unemployment, MDR-TB, urban residence, and previous incarceration.
- Mortality was high among defaulters (29.4%), with unemployment, HIV infection, sputum smear positivity, MDR-TB, and previous TB being significant predictors of mortality.
Conclusions:
- Risk factors for TB treatment default are largely modifiable and linked to socioeconomic disadvantages and specific clinical factors.
- Interventions should focus on supporting socially disadvantaged patients, addressing alcohol abuse, and prioritizing care for MDR-TB patients to reduce default and mortality.
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