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Open Access Highly Accessed Research article

Factors associated with mortality in patients with tuberculosis

David J Horne1*, Rebecca Hubbard23, Masahiro Narita145, Alexia Exarchos6, David R Park1 and Christopher H Goss1

Author Affiliations

1 Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA

2 Group Health Center for Health Studies, Seattle, WA, USA

3 Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA

4 Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA

5 Public Health - Seattle & King County, Tuberculosis Control Program, Seattle, WA, USA

6 Washington State Department of Health, Infectious Disease and Reproductive Health Assessment Unit, Olympia, WA, USA

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BMC Infectious Diseases 2010, 10:258  doi:10.1186/1471-2334-10-258

Published: 27 August 2010

Abstract

Background

Known risk factors for death following a diagnosis of tuberculosis may not be applicable to current U.S. cases. We evaluated the factors associated with all-cause mortality in patients with tuberculosis in Washington State.

Methods

Using data from the Tuberculosis Information Management System of Washington State, we conducted a cohort study of all residents diagnosed with tuberculosis from 1993 through 2005. Death from any cause was ascertained through the Washington State Death Certificate Data Files. Proportional hazards models were used to estimate the independent effect on all-cause mortality of demographic, clinical, and behavioral characteristics.

Results

During a median follow-up of 6 years in 3451 patients treated for tuberculosis, there were 417 deaths. Mortality was independently associated with increasing age, male gender, HIV-coinfection, and U.S. birth. Within 1 year of tuberculosis diagnosis, treatment by a private provider and the use of directly observed therapy were also independently associated with increased mortality. In addition, an interaction term of private provider times directly observed therapy was also significantly associated with mortality.

Conclusions

We identified factors independently associated with increased all-cause mortality following a diagnosis of tuberculosis. The associations between mortality and provider type should be evaluated with more thorough adjustment for severity of illness, but suggest important directions for future research.