Risk of pulmonary aspergillosis in tuberculosis survivors: A nationwide population-based study

To evaluate the long-term risk of pulmonary aspergillosis among tuberculosis (TB) survivors and identify risk factors associated with its development.

Using data from Korea's Healthcare Big Data platform, which integrates information from the Korea National Health Insurance Service and the Korea Centers for Disease Control and Prevention, we conducted a retrospective cohort study including 13 653 TB survivors and 40 959 matched controls without a history of TB.

During a median follow-up of 5.4 years, the incidence of pulmonary aspergillosis was markedly higher among TB survivors than controls (0.89 vs. 0.09 per 1000 person-years; P < 0.001), corresponding to an adjusted hazard ratio (aHR) of 6.84 (95% confidence interval [CI], 3.89-12.1). Among TB survivors, low body mass index (aHR, 2.06; 95% CI, 1.11-3.82), diabetes mellitus (aHR, 4.45; 95% CI, 2.56-7.73), connective tissue disease (aHR, 23.19; 95% CI, 2.99-179.63), and bronchiectasis (aHR, 2.55; 95% CI, 1.08-6.04) were independently associated with pulmonary aspergillosis.

TB survivors are at a substantially increased risk of pulmonary aspergillosis compared with individuals without a history of TB. Long-term surveillance and risk-based management strategies should be considered for this high-risk population.