Determinants of unsuccessful treatment outcomes and mortality among tuberculosis patients in Malaysia: A registry-based cohort study

• Main Authors: Chinna, K. (Author), Ismail, N. (Author), Kadir, N.A (Author), Keng Tok, P.S (Author), Liew, S.M (Author), Loganathan, T. (Author), Razali, A. (Author), Wong, L.P (Author)
• Format: Article
• Language: English
• Published: Public Library of Science, 2020
• Subjects: adolescent; Adolescent; adult; Adult; age; aged; Aged; all cause mortality; Antitubercular Agents; Article; child; Child; Child, Preschool; cohort analysis; diabetes mellitus; disease surveillance; educational status; epidemiology; ethnicity; female; Female; follow up; gender; HIV Seropositivity; human; Human immunodeficiency virus infection; Humans; lung tuberculosis; major clinical study; Malaysia; Malaysian; male; Male; medical history; middle aged; Middle Aged; mortality; Mycobacterium tuberculosis; preschool child; Retrospective Studies; retrospective study; risk assessment; rural population; smoking; sputum smear; thorax radiography; treatment failure; Treatment Failure; tuberculosis; Tuberculosis; tuberculostatic agent; virology; young adult; Young Adult
• Online Access: View Fulltext in Publisher; View in Scopus

 Introduction The monitoring of tuberculosis (TB) treatment outcomes and examination of the factors affecting these outcomes are important for evaluation and feedback of the national TB control program. This study aims to assess the TB treatment outcomes among patients registered in the national TB surveillance database in Malaysia from 2014 until 2017 and identify factors associated with unsuccessful treatment outcomes and all-cause mortality. Materials and methods Using registry-based secondary data, a retrospective cohort study was conducted. TB patients' sociodemographic characteristics, clinical disease data and treatment outcomes at one-year surveillance were extracted from the database and analyzed. Logistic regression analysis was used to determine factors associated with unsuccessful treatment outcomes and all-cause mortality. Results A total of 97,505 TB cases (64.3% males) were included in this study. TB treatment success (cases categorized as cured and completed treatment) was observed in 80.7% of the patients. Among the 19.3% patients with unsuccessful treatment outcomes, 10.2% died, 5.3% were lost to follow-up, 3.6% had outcomes not evaluated while the remaining failed treatment. Unsuccessful TB treatment outcomes were found to be associated with older age, males, foreign nationality, urban dwellers, lower education levels, passive detection of TB cases, absence of bacille Calmette-Guerin (BCG) scar, underlying diabetes mellitus, smoking, extrapulmonary TB, history of previous TB treatment, advanced chest radiography findings and human immunodeficiency virus (HIV) infection. Factors found associated with all-cause mortality were similar except for nationality (higher among Malaysians) and place of residence (higher among rural dwellers), while smoking and history of previous TB treatment were not found to be associated with all-cause mortality. Conclusions This study identified various sociodemographic characteristics and TB disease-related variables which were associated with unsuccessful TB treatment outcomes and mortality; these can be used to guide measures for risk assessment and stratification of TB patients in future. Copyright: © 2020 Tok et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.