Mortality among tuberculosis cases in Victoria, 2002-2013: case fatality and factors associated with death

The state of Victoria, Australia, is an industrialised setting with low tuberculosis (TB) incidence, universal health care and high levels of migration.

To assess case fatality rates (CFRs) and factors associated with death in a cohort of TB cases notified between 2002 and 2013.

Retrospective cohort study. Cases who died untreated or during treatment were reviewed to determine whether TB was a primary cause of, contributed to or was unrelated to death. Descriptive and multivariate analyses were used to compare demographic, clinical and pathological characteristics.

Of 3956 cases, 198 (5.0%) died of any cause. TB was the primary cause of death in 99 cases (50.3%) and contributed to death in a further 34 cases, giving a TB-related CFR of 3.4%. In multivariate analysis, TB-related mortality reduced over time, and was positively associated with male sex, older age, history of substance use and disseminated or meningeal TB. Factors associated with survival included having a history of past travel to or residence in a high TB risk country, lymph node TB or extra-pulmonary TB manifestations, excluding meningeal, genitourinary, pleural and lymphnode TB.

TB CFRs in this setting are among the lowest reported globally. TB mortality steadily decreased from 2002 to 2013.