Post-treatment Mortality Among Patients With Tuberculosis: A Prospective Cohort Study of 10 964 Patients in Vietnam

• Published in: Clinical infectious diseases Vol. 68; no. 8; pp. 1359 - 1366
• Main Authors: Fox, G J, Nguyen, V N, Dinh, N S, Nghiem, L P H, Le, T N A, Nguyen, T A, Nguyen, B H, Nguyen, H D, Tran, N B, Nguyen, T L, Le, T N, Nguyen, V H, Phan, T L, Nguyen, K C, Ho, J, Pham, D C, Britton, W J, Bestrashniy, J R B M, Marks, G B
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 08.04.2019
• Subjects: recurrence; mortality; pulmonary; multi-drug resistant; tuberculosis
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciy665

This prospective cohort study followed patients with tuberculosis in Vietnam for 3 years after diagnosis. During that time, 8.9% of patients died: two-thirds after treatment completion.Recurrent tuberculosis and cardiovascular disease were major causes of death, as identified in verbal autopsies. Abstract Background Tuberculosis is the leading infectious cause of death. Steep reductions in tuberculosis-related mortality are required to realize the World Health Organization’s “End Tuberculosis Strategy.” However, accurate mortality estimates are lacking in many countries, particularly following discharge from care. This study aimed to establish the mortality rate among patients with pulmonary tuberculosis in Vietnam and to quantify the excess mortality in this population. Methods We conducted a prospective cohort study among adult patients treated for smear-positive pulmonary tuberculosis in 70 clinics across Vietnam. People living in the same households were recruited as controls. Participants were re-interviewed and their survival was established at least 2 years after their treatment with an 8-month standardized regimen. The presence of relapse was established by linking identifying data on patients and controls to clinic registries. Verbal autopsies were performed. The cumulative mortality among patients was compared to that among a control population, adjusting for age and gender. Results We enrolled 10964 patients and 25707 household controls. Among enrolled tuberculosis patients, 9% of patients died within a median follow-up period of 2.9 years: 342 (3.1%) during treatment and 637 (5.8%) after discharge. The standardized mortality ratio was 4.0 (95% confidence interval 3.7–4.2) among patients with tuberculosis, compared to the control population. Tuberculosis was the likely cause of death for 44.7% of these deceased patients. Conclusions Patients treated for tuberculosis had a markedly elevated risk of death, particularly in the post-treatment period. Interventions to reduce tuberculosis mortality must enhance the early detection of drug-resistance, improve treatment effectiveness, and address non-communicable diseases.