Research article

Risk factors for poor tuberculosis treatment outcome in Finland: a cohort study

Tuula Vasankari^1,2 , Pekka Holmström¹ , Jukka Ollgren¹ , Kari Liippo² , Maarit Kokki¹ and Petri Ruutu¹

¹Department of Infectious Disease Epidemiology, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland

²Department of Respiratory Medicine, Turku University Hospital, Paimio Hospital, Alvar Aallon tie 275, 21540 Preitilä, Finland

author email corresponding author email

BMC Public Health 2007, 7:291doi:10.1186/1471-2458-7-291

Published:	14 October 2007

Abstract

Background

We investigated the patient- and treatment-system dependent factors affecting treatment outcome in a two-year cohort of all treated culture-verified pulmonary tuberculosis (TB) cases to establish a basis for improving outcomes.

Methods

Medical records of all cases in 1995 – 1996 were abstracted to assess outcome of treatment. Outcome was divided into three groups: favourable, death and other unfavourable. Predictors of unfavourable outcome were assessed in univariate and multivariate analysis.

Results

Among 629 cases a favourable outcome was achieved in 441 (70.1%), 17.2% (108) died and other unfavourable outcome took place in 12.7% (80). Significant independent risk factors for death were male sex, high age, non-HIV -related immunosuppression and any other than a pulmonary specialty being responsible for stopping treatment. History of previous tuberculosis was inversely associated with the risk of death. For other unfavourable treatment outcomes, significant risk factors were pause(s) in treatment, treatment with INH+RIF+EMB/SM, and internal medicine specialty being responsible at the end of the treatment.

Conclusion

We observed a significant association with unfavourable outcome for the specialty responsible for treatment being other than pulmonary, but not for the volume of cases, which has implications for system arrangements. Poor outcomes associated with immunosuppression and advanced age, with frequent comorbidity, stress a low threshold of suspicion, availability of rapid diagnostics, and early empiric treatment as probable approaches in attempting to improve treatment outcomes in countries with very low incidence of TB.