Risk factors for excess mortality and death in adults with tuberculosis in Western Kenya.
| Autor: | van't Hoog AH; Kenya Medical Research Institute, Centers for Disease Control and Prevention Research and Public Health Collaboration, Kisumu, Kenya. a.h.vanthoog@amc.uva.nl, Williamson J, Sewe M, Mboya P, Odeny LO, Agaya JA, Amolloh M, Borgdorff MW, Laserson KF |
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| Jazyk: | angličtina |
| Zdroj: | The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease [Int J Tuberc Lung Dis] 2012 Dec; Vol. 16 (12), pp. 1649-56. |
| DOI: | 10.5588/ijtld.12.0135 |
| Abstrakt: | 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%. |
| Databáze: | MEDLINE |
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