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Free Content Quantifying errors in the estimation of tuberculosis mortality in a population of South African miners

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Abstract:

BACKGROUND: All-cause mortality, based on national tuberculosis programme (NTP) register deaths, may under- or overestimate tuberculosis (TB) specific mortality in the population.

OBJECTIVE: To assess the factors influencing this measurement in a single large population with high TB prevalence and mortality.

METHODS: Routinely collected data on TB cases and treatment outcomes were linked to population data from a cohort of South African miners from 1995 to 2008. Vital status and cause of death were determined from multiple sources, including the TB programme, death register and autopsy.

RESULTS: The TB mortality rate, based on 430 deaths on the TB register, was 192/100 000 person-years (py). Many of these deaths (57%) were not caused by TB, and 483 TB deaths were identified outside the programme. Overall, there were 674 TB-specific deaths; the TB-specific mortality rate was 302/100 000 py. These deaths included 191 (28%) on the TB register, 23 (3%) among defaulters/transfers, 153 (23%) after anti-tuberculosis treatment and 307 (46%) in men who had never been on the programme.

CONCLUSIONS: This study highlights methodological issues in estimating TB mortality. In this population, a method using the product of TB incidence and case fatality consistently underestimated TB mortality. Accurate estimates of TB-specific mortality are crucial for the proper evaluation of TB control programmes.

Keywords: autopsy; cause of death; mortality; treatment outcome; tuberculosis

Document Type: Research Article

DOI: http://dx.doi.org/10.5588/ijtld.12.0086

Affiliations: 1: Research Department of Infection and Population Health, University College London, London, UK 2: Rustenburg Platinum Mines Limited, Rustenburg, South Africa 3: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK 4: National Institute for Occupational Health, National Health Laboratory Service and School of Public Health, University of the Witwatersrand, Johannesburg, South Africa

Publication date: November 1, 2012

More about this publication?
  • 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.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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