Mortality before or during treatment among tuberculosis patients in North Carolina, 1993-2003

Abstract

SETTING: North Carolina, United States. OBJECTIVE: To investigate the demographic and behavioral risk factors associated with death among tuberculosis (TB) patients in North Carolina. DESIGN: Retrospective cohort of all TB patients reported in North Carolina, 1993-2003 (inclusive). A surveillance dataset based upon Report of Verified Case of Tuberculosis (RVCT) records was cross-linked with the National Death Index (NDI) to confirm date of death and capture additional deaths. RESULTS: Among 5311 TB patients, 181 died before initiation of TB treatment, and 540 died before completion of TB treatment. Increasing age, miliary/meningeal disease, and human immunodeficiency virus (HIV) infection were associated with increased risk of death before treatment, during early treatment (initial 8 weeks) and later in TB treatment. In addition to these factors, excess alcohol use (HR 1.62, 95%CI 1.13-2.32) and residence in a nursing home (HR 1.65, 95%CI 1.20-2.29) were associated with a significantly increased risk of death during the first 8 weeks of treatment. CONCLUSION: Many of the deaths in TB patients occurred in the most vulnerable populations, such as the elderly or those with HIV infection, and may be attributable to delayed diagnosis and poor functional status