Tuberculosis Mortality in the United States: Epidemiology and Prevention Opportunities

• Type of Material: Article
• Authors: Neela Goswami, Emory University; Suzanne Beavers, Emory University; Lisa Pascopella, California Department of Public Health; Amy L. Davidow, Rutgers University; Joan M. Mangan, Centers for Disease Control and Prevention; Yael R. Hirsch-Moverman, Columbia University; Jonathan E. Golub, Johns Hopkins University; Henry Michael Blumberg, Emory University; Risa M. Webb, University of Mississippi; Rachel A. Royce, Research Triangle Institute; Susan E. Buskin, Public Health Seattle and King County; Michael K. Leonard, Emory University; Paul C. Weinfurter, Westat, Inc.; Robert W. Belknap, Denver Public Health and Hospital Authority; Stephen E. Hughes, New York State Health Department; Jon V. Warkentin, Tennessee Department of Health; Sharon F. Welbel, Rush University; Thaddeus L. Miller, University of North Texas; Saini R. Kundipati, Respiratory Health Association of Metropolitan Chicago; Michael Lauzardo, University of Florida; Pennan M. Barry, California Department of Public Health; Dolly J. Katz, Centers for Disease Control and Prevention; Denise O. Garrett, Centers for Disease Control and Prevention; Edward A. Graviss, Houston Methodist Research Institute; Jennifer M. Flood, California Department of Public Health
• Language: English
• Date: 2018-06-01
• Publisher: American Thoracic Society
• Publication Version: Final Published Version
• Copyright Statement: Copyright © 2018 by the American Thoracic Society.
• Final Published Version (URL): http://dx.doi.org/10.1513/AnnalsATS.201705-405OC
• Title of Journal or Parent Work: Annals of the American Thoracic Society
• ISSN: 2329-6933
• Volume: 15
• Issue: 6
• Start Page: 683
• End Page: 692
• Grant/Funding Information: Supported by the Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, through a task order announced and managed by the Tuberculosis Epidemiologic Studies Consortium.
• Keywords: SURVEILLANCE; Life Sciences & Biomedicine; FOLLOW-UP; Science & Technology; RISK-FACTORS; IMPACT; PULMONARY TUBERCULOSIS; TREATMENT OUTCOMES; Respiratory System; DEATH CERTIFICATES; risk factors; COST-EFFECTIVENESS; INTENSIVE-CARE-UNIT; cause of death; IN-HOSPITAL MORTALITY; death certificates
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

Rationale: More information on risk factors for death from tuberculosis in the United States could help reduce the tuberculosis mortality rate, which has remained steady for more than a decade. Objective: To identify risk factors for tuberculosis-related death in adults. Methods: We performed a retrospective study of 1,304 adults with tuberculosis who died before treatment completion and 1,039 frequency-matched control subjects who completed tuberculosis treatment in 2005 to 2006 in 13 states reporting 65% of U.S. tuberculosis cases. We used in-depth record abstractions and a standard algorithm to classify deaths in persons with tuberculosis as tuberculosis-related or not. We then compared these classifications to causes of death as coded in death certificates. We used multivariable logistic regression to calculate adjusted odds ratios for predictors of tuberculosis-related death among adults compared with those who completed tuberculosis treatment. Results: Of 1,304 adult deaths, 942 (72%) were tuberculosis related, 272 (21%) were not, and 90 (7%) could not be classified. Of 847 tuberculosis-related deaths with death certificates available, 378 (45%) did not list tuberculosis as a cause of death. Adjusting for known risks, we identified new risks for tuberculosis-related death during treatment: absence of pyrazinamide in the initial regimen (adjusted odds ratio, 3.4; 95% confidence interval, 1.9-6.0); immunosuppressive medications (adjusted odds ratio, 2.5; 95% confidence interval, 1.1-5.6); incomplete tuberculosis diagnostic evaluation (adjusted odds ratio, 2.2; 95% confidence interval, 1.5-3.3), and an alternative nontuberculosis diagnosis before tuberculosis diagnosis (adjusted odds ratio, 1.6; 95% confidence interval, 1.2-2.2). Conclusions: Most persons who died with tuberculosis had a tuberculosis-related death. Intensive record review revealed tuberculosis as a cause of death more often than did death certificate diagnoses. New tools, such as a tuberculosis mortality risk score based on our study findings, may identify patients with tuberculosis for in-hospital interventions to prevent death.