Factors correlated with tuberculosis reported after death.

Area of Science:

• Public Health
• Epidemiology
• Infectious Diseases

Background:

• Tuberculosis (TB) remains a significant global health concern, particularly in its potential for delayed diagnosis and mortality.
• Understanding factors contributing to TB cases reported post-mortem is crucial for improving public health surveillance and patient outcomes.

Purpose of the Study:

• To identify demographic and clinical factors associated with tuberculosis cases that are reported after a patient's death.
• To inform strategies aimed at preventing delayed diagnosis and reducing premature mortality from TB, especially in vulnerable populations.

Main Methods:

• A retrospective cohort study analyzed data from TB patients newly registered in Taiwan between 2006 and 2008.
• National TB registry data were linked with the Vital Registry System and National Health Insurance database for comprehensive analysis.

Main Results:

• Approximately 4.0% (1409 cases) of TB diagnoses were reported after death.
• Factors associated with post-mortem TB reporting included advanced age (⩾75 years), unperformed or unknown chest X-rays, positive sputum bacteriology, and comorbidities like cancer, chronic liver disease, and chronic kidney disease.
• Elderly patients with chronic kidney disease represented over 30% of TB deaths reported post-mortem, highlighting a critical risk group.

Conclusions:

• Elderly patients diagnosed with TB, especially those with comorbidities such as cancer, chronic liver disease, or chronic kidney disease, require heightened clinical attention.
• Proactive interventions are necessary to prevent delayed diagnosis and mitigate early mortality in these high-risk TB patient groups.
• Chronic kidney disease in elderly TB patients presents the most significant risk factor for post-mortem case reporting and potentially preventable mortality.