Risk factors for death during tuberculosis treatment in Orel, Russia

Authors: Dewan P.K.¹; Arguin P.M.²; Kiryanova H.³; Kondroshova N.V.³; Khorosheva T.M.³; Laserson K.²; Kluge H.⁴; Jakubowiak W.⁴; Wells C.²; Kazionny B.³

Source: The International Journal of Tuberculosis and Lung Disease, Volume 8, Number 5, May 2004 , pp. 598-602(5)

Publisher: International Union Against Tuberculosis and Lung Disease

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The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.
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By this author: Dewan P.K. ; Arguin P.M. ; Kiryanova H. ; Kondroshova N.V. ; Khorosheva T.M. ; Laserson K. ; Kluge H. ; Jakubowiak W. ; Wells C. ; Kazionny B.

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Abstract:

SETTING AND METHODS: In Orel, high tuberculosis (TB) case fatality rates have persisted despite successful implementation of the World Health Organization (WHO) global TB control strategy. We conducted a case control study to identify risk factors for mortality among Orel TB patients reported from October 1999 through June 2001. Cases were patients who died within 8 months of treatment initiation. We analyzed data abstracted from medical records using conditional logistic regression.

RESULTS: Over the 21-month period, 63/1069 (5.9%) TB patients overall and 45/521 (8.6%) sputum smear-positive patients died during treatment. Compared to 192 controls, independent risk factors for death for both smear-positive and smear-negative patients included unemployment (adjusted odds ratio [AOR] 4.9, 95% confidence interval [CI] 1.9–12.9), homelessness (AOR 9.5, 95%CI 1.3–70.9), congestive heart failure (AOR 5.4, 95%CI 1.9–15.9), chronic lung disease (AOR 2.4, 95%CI 1.1–5.4), cancer (AOR 7.2, 95%CI 1.2–45.0), bilateral disease on chest X-ray (AOR 6.3, 95%CI 2.3–17.1), and hyperbilirubinemia (AOR 5.2, 95%CI 1.1–25.3). Among deaths, the median time from treatment initiation to death was 35 days.

CONCLUSIONS: The diagnosis and treatment of TB in suspects with the observed comorbidities and risk factors should be aggressively pursued. The association of unemployment and homelessness with mortality suggests a contribution of poverty to death during TB treatment.

Keywords: tuberculosis; epidemiology; mortality; Russia

Document Type: Regular paper

Affiliations: 1: Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Atlanta, Georgia, USA; and Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control 2: Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 3: Orel Oblast Central Tuberculosis Dispensary, Orel, Russia 4: World Health Organization, Office of the Special Representative of the Director General, Moscow, Russia