Publication date: Nov 20, 2024
Abstract Background: Even after successful treatment, tuberculosis (TB) survivors experience elevated morbidity and mortality. However, there is limited evidence on how these risks vary over time and according to individual characteristics. Methods: We conducted a retrospective cohort study of individuals diagnosed with TB in Brazil, using national TB notifications and linked mortality records for 2007-2016. For this study population we estimated mortality rate ratios (MRRs) and cumulative mortality by year since TB diagnosis, as compared to general population mortality rates matched on age, sex, year, and state. We identified clinical and sociodemographic factors associated with elevated post-TB mortality, and compared the distribution of causes of death to the general population. Findings: The study sample included 834,594 individuals, with 4.1 million person-years of follow-up. The TB cohort had elevated mortality compared to the general population, particularly in the first year post-diagnosis (MRR 11.28, 95%CI: 11.18-11.37). Post-TB MRRs declined from 3.59 (3.53-3.64) in year 2 to 1.46 (1.34-1.59) in year 10. Cumulative excess mortality was 6.12% (95%CI: 6.07-6.17) after 1 year and 9.90% (9.58-10.24) after 10 years. MRRs were highest for individuals 30-44 years-old at diagnosis. Relapse, loss to follow-up, and co-prevalent conditions like HIV and alcoholism were strongly associated with higher MRRs. Over time, causes of death shifted from TB and HIV to chronic conditions like cardiovascular disease and cancer. Interpretation: Individuals developing TB disease face elevated mortality up to 10 years after diagnosis. These excess risks vary across demographic and clinical characteristics. Funding: NIH.
| Concepts | Keywords |
|---|---|
| Harvard | Cohort |
| Socioeconomic | Compared |
| Tuberculosis | Death |
| Diagnosis | |
| General | |
| Individuals | |
| Medrxiv | |
| Mortality | |
| Mrrs | |
| Population | |
| Preprint | |
| Reference | |
| Sun | |
| Year | |
| Years |
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | tuberculosis |
| pathway | KEGG | Tuberculosis |
| disease | MESH | morbidity |
| disease | MESH | causes of death |
| disease | MESH | Relapse |
| disease | MESH | alcoholism |
| pathway | KEGG | Alcoholism |
| disease | MESH | chronic conditions |
| disease | MESH | cardiovascular disease |
| disease | MESH | cancer |
| disease | MESH | death |
| disease | IDO | infectious agent |
| disease | MESH | sequelae |
| disease | IDO | history |
| drug | DRUGBANK | Etoperidone |
| disease | MESH | educational attainment |
| disease | MESH | mental illness |
| disease | MESH | treatment failure |
| drug | DRUGBANK | Aspartame |
| disease | MESH | uncertainty |
| drug | DRUGBANK | Pentaerythritol tetranitrate |
| disease | MESH | respiratory diseases |
| disease | MESH | HIV infection |
| pathway | REACTOME | HIV Infection |
| disease | MESH | co infection |
| drug | DRUGBANK | Ethanol |
| pathway | REACTOME | Immune System |
| disease | IDO | country |
| disease | IDO | susceptibility |
| disease | MESH | non communicable diseases |
| disease | MESH | Lung Disease |