Risk factors for excess mortality and death in adults with tuberculosis in Western Kenya
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%.
Document Type: Research Article
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: 2012-12-01
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