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

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

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

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