Free Content Risk factors for excess mortality and death in adults with tuberculosis in Western Kenya

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Abstract:

OBJECTIVES: To evaluate excess mortality and risk factors for death during anti-tuberculosis treatment in Western Kenya.

METHODS: We abstracted surveillance data and compared mortality rates during anti-tuberculosis treatment with all-cause mortality from a health and demographic surveillance population to obtain standardised mortality ratios (SMRs). Risk factors for excess mortality were obtained using a relative survival model, and for death during treatment using a proportional hazards regression model.

RESULTS: The crude mortality rate during anti-tuberculosis treatment was 18.0 (95%CI 16.8–19.2) per 100 person-years. The age and sex SMR was 8.8 (95%CI 8.2–9.4). Excess mortality was greater in human immunodeficiency virus (HIV) positive TB patients (excess hazard ratio [eHR] 2.1, 95%CI 1.5–3.1), and lower in patients who were female or started treatment in a later year. Mortality was high in patients with unknown HIV status (HR 2.9, 95%CI 2.2–3.8) or, if HIV-positive, not on antiretroviral treatment (ART; HR 3.3, 95%CI 2.5–4.5) or not known to be on ART (HR 2.8, 95%CI 2.1–3.7). The attributable fraction of incomplete uptake of HIV testing and ART on mortality was 31% (95%CI 15–45) compared to HIV-positive patients on ART.

CONCLUSION: Increasing the uptake of HIV testing and ART would further reduce mortality during anti-tuberculosis treatment by an estimated 31%.

Keywords: HIV; Kenya; excess mortality; tuberculosis

Document Type: Research Article

DOI: http://dx.doi.org/10.5588/ijtld.12.0135

Affiliations: 1: Kenya Medical Research Institute, Centers for Disease Control and Prevention Research and Public Health Collaboration, Kisumu, Kenya; Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands 2: Kenya Medical Research Institute, Centers for Disease Control and Prevention Research and Public Health Collaboration, Kisumu, Kenya; Centers for Disease Control and Prevention, Center for Global Health, Atlanta, Georgia, USA 3: Kenya Medical Research Institute, Centers for Disease Control and Prevention Research and Public Health Collaboration, Kisumu, Kenya 4: Kenya Ministry of Health, Division of Leprosy, Tuberculosis and Lung Diseases, Kisumu, Kenya 5: Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Public Health Service, Department of Infectious Diseases, Amsterdam, The Netherlands

Publication date: December 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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