Longevity loss among cured tuberculosis patients and the potential value of prevention

• Published in: The international journal of tuberculosis and lung disease Vol. 18; no. 11; pp. 1347 - 1352
• Main Authors: Hoger, S., Lykens, K., Beavers, S. F., Katz, D., Miller, T. L.
• Format: Journal Article
• Language: English
• Published: Paris International Union Against Tuberculosis and Lung Disease 01.11.2014; International Union against Tuberculosis and Lung Disease
• Subjects: Adolescent; Adult; Aged; Antitubercular Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Cohort Studies; Databases, Factual; Female; Human bacterial diseases; Humans; Infectious diseases; Latent Tuberculosis - drug therapy; Latent Tuberculosis - mortality; Longevity; Male; Medical sciences; Middle Aged; Mortality; Mycobacterium; Pneumology; Premature Death; Regression; Regression Analysis; Retrospective Studies; Survivors; Tuberculosis - drug therapy; Tuberculosis - mortality; Tuberculosis and atypical mycobacterial infections; Young Adult; Human; Premature; Prognosis; Respiratory disease; Mortality; Loss; Regression; Patient; Mycobacterial infection; Longevity; Potential; premature death; Epidemiology; Infection; Prevention; Tuberculosis; Bacteriosis; Death
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.14.0242

BACKGROUND: Evidence of substantial, quantifiable and preventable burdens of mortality hazard even after anti-tuberculosis treatment and cure would be a compelling, concrete, and useful measure of the value of prevention.METHODS: We compared years of potential life lost between a cohort of 3 933 cured tuberculosis (TB) patients and 9 166 persons with latent tuberculous infection. We constructed a regression model to predict the expected years of potential life lost in each cohort and for demographic subgroups.RESULTS: Among decedents, a history of fully treated TB is associated with a predicted average 3.6 more years of potential life loss than a comparable population without active TB. Greater longevity losses were predicted among those identified as White and Hispanic than among Black and Asian counterparts.CONCLUSION: We found significant differences in predicted longevity of treated TB survivors relative to a similar group without active TB. These excess losses are substantial: a total of 14 158 life-years or the equivalent of more than 188 75-year lifespans. These findings illustrate an important opportunity cost associated with each preventable TB case - an average of 3.6 potential years of life. We conclude that substantial preventable mortality burdens remain despite adequate anti-tuberculosis treatment, a compelling rationale for more widespread and systematic use of prevention.