A nested case-control study of predictors for tuberculosis recurrence in a large UK Centre

Area of Science:

• Infectious Diseases
• Epidemiology
• Public Health

Background:

• Tuberculosis (TB) recurrence poses a significant challenge to global control efforts.
• Risk factors for TB recurrence in low-incidence countries remain poorly understood.

Purpose of the Study:

• To identify clinical, sociodemographic, and TB-specific risk factors associated with TB recurrence.
• To characterize the prevailing risk factors in a low-incidence setting.

Main Methods:

• A nested case-control study was conducted using the Leicester TB service TBIT database (1994-2014).
• Multivariate conditional logistic regression analysis was employed to identify independent predictors of recurrence.
• Multiple imputation was used to handle missing data.

Main Results:

• Out of 4628 patients, 82 (1.8%) experienced TB recurrence, predominantly relapses (84%).
• Independent predictors of TB recurrence included smoking (OR 3.8), grade 3/4 adverse drug reactions (OR 5.6), specific ethnicities (Indian subcontinent OR 8.5; other OR 31.2), and immunosuppressant use (OR 6.8).

Conclusions:

• The rate of TB recurrence in this UK cohort was low, with relapse being the primary cause.
• Elevated recurrence risk within specific ethnic groups highlights an opportunity for targeted interventions to improve individual and public health.