Mortality during treatment for tuberculosis; a review of surveillance data in a rural county in Kenya
Globally in 2016, 1.7 million people died of Tuberculosis (TB). This study aimed to estimate all-cause mortality rate, identify features associated with mortality and describe trend in mortality rate from treatment initiation. A 5-year (2012-2016) retrospective analysis of electronic TB surveillance...
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| creator | Abdullahi, Osman A Ngari, Moses M Sanga, Deche Katana, Geoffrey Willetts, Annie |
| description | Globally in 2016, 1.7 million people died of Tuberculosis (TB). This study aimed to estimate all-cause mortality rate, identify features associated with mortality and describe trend in mortality rate from treatment initiation.
A 5-year (2012-2016) retrospective analysis of electronic TB surveillance data from Kilifi County, Kenya. The outcome was all-cause mortality within 180 days after starting TB treatment. The risk factors examined were demographic and clinical features at the time of starting anti-TB treatment. We performed survival analysis with time at risk defined from day of starting TB treatment to time of death, lost-to-follow-up or completing treatment. To account for 'lost-to-follow-up' we used competing risk analysis method to examine risk factors for all-cause mortality.
10,717 patients receiving TB treatment, median (IQR) age 33 (24-45) years were analyzed; 3,163 (30%) were HIV infected. Overall, 585 (5.5%) patients died; mortality rate of 12.2 (95% CI 11.3-13.3) deaths per 100 person-years (PY). Mortality rate increased from 7.8 (95% CI 6.4-9.5) in 2012 to 17.7 (95% CI 14.9-21.1) in 2016 per 100PY (Ptrend |
| doi_str_mv | 10.1371/journal.pone.0219191 |
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A 5-year (2012-2016) retrospective analysis of electronic TB surveillance data from Kilifi County, Kenya. The outcome was all-cause mortality within 180 days after starting TB treatment. The risk factors examined were demographic and clinical features at the time of starting anti-TB treatment. We performed survival analysis with time at risk defined from day of starting TB treatment to time of death, lost-to-follow-up or completing treatment. To account for 'lost-to-follow-up' we used competing risk analysis method to examine risk factors for all-cause mortality.
10,717 patients receiving TB treatment, median (IQR) age 33 (24-45) years were analyzed; 3,163 (30%) were HIV infected. Overall, 585 (5.5%) patients died; mortality rate of 12.2 (95% CI 11.3-13.3) deaths per 100 person-years (PY). Mortality rate increased from 7.8 (95% CI 6.4-9.5) in 2012 to 17.7 (95% CI 14.9-21.1) in 2016 per 100PY (Ptrend<0.0001). 449/585 (77%) of the deaths occurred within the first three months after starting TB treatment. The median time to death (IQR) declined from 87 (40-100) days in 2012 to 46 (18-83) days in 2016 (Ptrend = 0·04). Mortality rate per 100PY was 7.3 (95% CI 6.5-7.8) and 23.1 (95% CI 20.8-25.7) among HIV-uninfected and HIV-infected patients respectively. Age, being a female, extrapulmonary TB, being undernourished, HIV infected and year of diagnosis were significantly associated with mortality.
We found most deaths occurred within three months and an increasing mortality rate during the time under review among patients on TB treatment. Our results therefore warrant further investigation to explore host, disease or health system factors that may explain this trend.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0219191</identifier><identifier>PMID: 31295277</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Antitubercular Agents - adverse effects ; Antitubercular Agents - therapeutic use ; BCG ; Biology and Life Sciences ; Care and treatment ; Death ; Demographic aspects ; Demographics ; Fatalities ; Female ; Forecasts and trends ; Health risks ; HIV ; HIV Infections - complications ; HIV Infections - drug therapy ; HIV Infections - microbiology ; HIV Infections - mortality ; HIV patients ; Human immunodeficiency virus ; Humans ; Intelligence gathering ; Kenya ; Kenya - epidemiology ; Male ; Medical diagnosis ; Medicine and Health Sciences ; Middle Aged ; Mortality ; Patient outcomes ; Patients ; Privacy ; Retrospective Studies ; Risk analysis ; Risk Factors ; Rural Population ; Surveillance ; Survival Analysis ; Systematic review ; Trends ; Tuberculosis ; Tuberculosis - complications ; Tuberculosis - drug therapy ; Tuberculosis - microbiology ; Tuberculosis - mortality ; Young Adult</subject><ispartof>PloS one, 2019-07, Vol.14 (7), p.e0219191-e0219191</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Abdullahi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Abdullahi et al 2019 Abdullahi et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-a422d48bff8d5e9289105c28bdf732d01c6e76e5bde9dc1931aa84d1eaa3fab3</citedby><cites>FETCH-LOGICAL-c692t-a422d48bff8d5e9289105c28bdf732d01c6e76e5bde9dc1931aa84d1eaa3fab3</cites><orcidid>0000-0001-5003-2973</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6622488/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6622488/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,729,782,786,866,887,2106,2932,23875,27933,27934,53800,53802</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31295277$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Dodd, Peter J.</contributor><creatorcontrib>Abdullahi, Osman A</creatorcontrib><creatorcontrib>Ngari, Moses M</creatorcontrib><creatorcontrib>Sanga, Deche</creatorcontrib><creatorcontrib>Katana, Geoffrey</creatorcontrib><creatorcontrib>Willetts, Annie</creatorcontrib><title>Mortality during treatment for tuberculosis; a review of surveillance data in a rural county in Kenya</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Globally in 2016, 1.7 million people died of Tuberculosis (TB). This study aimed to estimate all-cause mortality rate, identify features associated with mortality and describe trend in mortality rate from treatment initiation.
A 5-year (2012-2016) retrospective analysis of electronic TB surveillance data from Kilifi County, Kenya. The outcome was all-cause mortality within 180 days after starting TB treatment. The risk factors examined were demographic and clinical features at the time of starting anti-TB treatment. We performed survival analysis with time at risk defined from day of starting TB treatment to time of death, lost-to-follow-up or completing treatment. To account for 'lost-to-follow-up' we used competing risk analysis method to examine risk factors for all-cause mortality.
10,717 patients receiving TB treatment, median (IQR) age 33 (24-45) years were analyzed; 3,163 (30%) were HIV infected. Overall, 585 (5.5%) patients died; mortality rate of 12.2 (95% CI 11.3-13.3) deaths per 100 person-years (PY). Mortality rate increased from 7.8 (95% CI 6.4-9.5) in 2012 to 17.7 (95% CI 14.9-21.1) in 2016 per 100PY (Ptrend<0.0001). 449/585 (77%) of the deaths occurred within the first three months after starting TB treatment. The median time to death (IQR) declined from 87 (40-100) days in 2012 to 46 (18-83) days in 2016 (Ptrend = 0·04). Mortality rate per 100PY was 7.3 (95% CI 6.5-7.8) and 23.1 (95% CI 20.8-25.7) among HIV-uninfected and HIV-infected patients respectively. Age, being a female, extrapulmonary TB, being undernourished, HIV infected and year of diagnosis were significantly associated with mortality.
We found most deaths occurred within three months and an increasing mortality rate during the time under review among patients on TB treatment. 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abdullahi, Osman A</au><au>Ngari, Moses M</au><au>Sanga, Deche</au><au>Katana, Geoffrey</au><au>Willetts, Annie</au><au>Dodd, Peter J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mortality during treatment for tuberculosis; a review of surveillance data in a rural county in Kenya</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-07-11</date><risdate>2019</risdate><volume>14</volume><issue>7</issue><spage>e0219191</spage><epage>e0219191</epage><pages>e0219191-e0219191</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Globally in 2016, 1.7 million people died of Tuberculosis (TB). This study aimed to estimate all-cause mortality rate, identify features associated with mortality and describe trend in mortality rate from treatment initiation.
A 5-year (2012-2016) retrospective analysis of electronic TB surveillance data from Kilifi County, Kenya. The outcome was all-cause mortality within 180 days after starting TB treatment. The risk factors examined were demographic and clinical features at the time of starting anti-TB treatment. We performed survival analysis with time at risk defined from day of starting TB treatment to time of death, lost-to-follow-up or completing treatment. To account for 'lost-to-follow-up' we used competing risk analysis method to examine risk factors for all-cause mortality.
10,717 patients receiving TB treatment, median (IQR) age 33 (24-45) years were analyzed; 3,163 (30%) were HIV infected. Overall, 585 (5.5%) patients died; mortality rate of 12.2 (95% CI 11.3-13.3) deaths per 100 person-years (PY). Mortality rate increased from 7.8 (95% CI 6.4-9.5) in 2012 to 17.7 (95% CI 14.9-21.1) in 2016 per 100PY (Ptrend<0.0001). 449/585 (77%) of the deaths occurred within the first three months after starting TB treatment. The median time to death (IQR) declined from 87 (40-100) days in 2012 to 46 (18-83) days in 2016 (Ptrend = 0·04). Mortality rate per 100PY was 7.3 (95% CI 6.5-7.8) and 23.1 (95% CI 20.8-25.7) among HIV-uninfected and HIV-infected patients respectively. Age, being a female, extrapulmonary TB, being undernourished, HIV infected and year of diagnosis were significantly associated with mortality.
We found most deaths occurred within three months and an increasing mortality rate during the time under review among patients on TB treatment. Our results therefore warrant further investigation to explore host, disease or health system factors that may explain this trend.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31295277</pmid><doi>10.1371/journal.pone.0219191</doi><tpages>e0219191</tpages><orcidid>https://orcid.org/0000-0001-5003-2973</orcidid><oa>free_for_read</oa></addata></record> |
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| issn | 1932-6203 1932-6203 |
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| source | Public Library of Science (PLoS) Journals Open Access; MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adult Antitubercular Agents - adverse effects Antitubercular Agents - therapeutic use BCG Biology and Life Sciences Care and treatment Death Demographic aspects Demographics Fatalities Female Forecasts and trends Health risks HIV HIV Infections - complications HIV Infections - drug therapy HIV Infections - microbiology HIV Infections - mortality HIV patients Human immunodeficiency virus Humans Intelligence gathering Kenya Kenya - epidemiology Male Medical diagnosis Medicine and Health Sciences Middle Aged Mortality Patient outcomes Patients Privacy Retrospective Studies Risk analysis Risk Factors Rural Population Surveillance Survival Analysis Systematic review Trends Tuberculosis Tuberculosis - complications Tuberculosis - drug therapy Tuberculosis - microbiology Tuberculosis - mortality Young Adult |
| title | Mortality during treatment for tuberculosis; a review of surveillance data in a rural county in Kenya |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-11-29T10%3A49%3A36IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Mortality%20during%20treatment%20for%20tuberculosis;%20a%20review%20of%20surveillance%20data%20in%20a%20rural%20county%20in%20Kenya&rft.jtitle=PloS%20one&rft.au=Abdullahi,%20Osman%20A&rft.date=2019-07-11&rft.volume=14&rft.issue=7&rft.spage=e0219191&rft.epage=e0219191&rft.pages=e0219191-e0219191&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0219191&rft_dat=%3Cgale_plos_%3EA592987677%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2256177288&rft_id=info:pmid/31295277&rft_galeid=A592987677&rft_doaj_id=oai_doaj_org_article_507aeb6847ee4d0d87dda05e466275e9&rfr_iscdi=true |