Healthcare Utilization After Respiratory Tuberculosis: A Controlled Interrupted Time Series Analysis.

Autor:	Romanowski K; Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.; Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada., Law MR; Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, British Columbia, Canada.; School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada., Karim ME; School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada., Campbell JR; Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada.; McGill International TB Centre, McGill University, Montreal, Quebec, Canada.; Departments of Medicine & Global and Public Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada., Hossain MB; School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada., Gilbert M; School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.; Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada., Cook VJ; Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.; Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada., Johnston JC; Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.; Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.; McGill International TB Centre, McGill University, Montreal, Quebec, Canada.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2023 Sep 18; Vol. 77 (6), pp. 883-891.
DOI:	10.1093/cid/ciad290
Abstrakt:	Background: Despite data suggesting elevated morbidity and mortality among people who have survived tuberculosis disease, the impact of respiratory tuberculosis on healthcare utilization in the years following diagnosis and treatment remains unclear. Methods: Using linked health administrative data from British Columbia, Canada, we identified foreign-born individuals treated for respiratory tuberculosis between 1990 and 2019. We matched each person with up to four people without a tuberculosis diagnosis from the same source cohort using propensity score matching. Then, using a controlled interrupted time series analysis, we measured outpatient physician encounters and inpatient hospital admissions in the 5 years following respiratory tuberculosis diagnosis and treatment. Results: We matched 1216 individuals treated for respiratory tuberculosis to 4864 non-tuberculosis controls. Immediately following the tuberculosis diagnostic and treatment period, the monthly rate of outpatient encounters in the tuberculosis group was 34.0% (95% confidence interval [CI]: 30.7%, 37.2%) higher than expected, and this trend was sustained for the duration of the post-tuberculosis period. The excess utilization represented an additional 12.2 (95% CI: 10.6, 14.9) outpatient encounters per person over the post-tuberculosis period, with respiratory morbidity a large contributor to the excess healthcare utilization. Results were similar for hospital admissions, with an additional 0.4 (95% CI: .3, .5) hospital admissions per person over the post-tuberculosis period. Conclusions: Respiratory tuberculosis appears to have long-term impacts on healthcare utilization beyond treatment. These findings underscore the need for screening, assessment, and treatment of post-tuberculosis sequelae, as it may provide an opportunity to improve health and reduce resource use. Competing Interests: Potential conflicts of interest. K. R. reports travel support from CIHR (paid to institution). M. R. L. reports grants or contracts from CIHR and BC Ministry of Health (paid to institution); consulting fees from Health Canada, iTAD Ltd, and Canadian Agency for Drugs and Technologies in Health (CADTH) (paid to author); payment for expert testimony from Federation of Post-secondary Educators and Durham Police Association (paid to author). M. E. K. reports grants or contracts from Michael Smith Health Research BC (as reported in funding) and Natural Sciences and Engineering Research Council of Canada (both paid to institution). V. J. C. reports travel support for conferences from BC Center for Disease Control (BCCDC); participation as an independent data safety monitoring committee (IDMC) member for ACT5; and an unpaid role as board member for the BC Lung Foundation. M. G. reports travel support from CIHR Canadian HIV Trials Network (research collaborative). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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