Profile and treatment outcomes of elderly patients with tuberculosis in Delhi, India: implications for their management

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene Vol. 107; no. 12; pp. 763 - 768
• Main Authors: Patra, S., Lukhmana, S., Tayler Smith, K., Kannan, A.T., Satyanarayana, S., Enarson, D.A., Nagar, R.K., Marcel, M., Reid, T.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.12.2013
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Antitubercular Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Cohort Studies; Female; General aspects; Health Services Accessibility; Human bacterial diseases; Humans; India - epidemiology; Infectious diseases; Male; Mass Screening; Medical sciences; Middle Aged; Retrospective Studies; Risk Factors; Sex Factors; Treatment Outcome; Tuberculosis - drug therapy; Tuberculosis - epidemiology; Tuberculosis and atypical mycobacterial infections; Young Adult; Delhi; Asia; India; Treatment outcomes; Tuberculosis; Elderly; India; Human; Infection; Clinical management; Prognosis; Treatment; Bacteriosis; Tropical medicine; Mycobacterial infection
• ISSN: 0035-9203; 1878-3503
• DOI: 10.1093/trstmh/trt094

Background Given India's high rate of TB, rising burden of non-communicable diseases (NCDs) and growing elderly population, elderly TB patients may be at higher risk of adverse outcomes including death, loss-to-follow-up (LTFU) and treatment failure. This may call for modifications in their management. This study thus aimed to compare the profile and treatment outcomes between elderly (≥60 years) and non-elderly (15-59 years) TB patients. Methods This was a retrospective cohort study using routinely-collected programme data from a chest clinic in Delhi, India. It included all elderly and selected non-elderly TB patients registered for treatment between 2005 and 2010. Data on patients' clinical and demographic characteristics and treatment outcomes were analysed. Results There were 812 elderly and 1624 non-elderly TB patients. Elderly patients were more likely to be male (63.2% vs 51.1%) and have smear-positive TB (56.0% vs 47.4%). Adverse outcomes were more frequent among elderly patients (adjusted OR 1.9, 95% CI: 1.5-2.4), specifically deaths (adjusted OR 5.0, 95% CI: 3.1-8.1) and lost-to-follow-up (adjusted OR 1.4, 95% CI: 1.0-1.9). Conclusions The profile and worse outcomes of elderly Indian TB patients may be indicative of co-existing NCDs. This needs further investigation and likely calls for a more comprehensive and intensive approach to their management.