8 Citations (Scopus)

Abstract

Background and objective: Studies focusing on pulmonary tuberculosis in advanced age (≥80 years) are lacking. This study aimed to explore treatment delay, outcomes and their predictors in this group. Methods: Adult (≥20 years) patients with pulmonary tuberculosis were identified from the National Health Insurance Research Database of Taiwan from 2004 to 2009. Treatment completion and mortality rates were noted at one year after treatment. Results: Among the 81,081 patients with pulmonary tuberculosis identified, 13,923 (17.2%) were aged ≥80 years, and 26,897 (33.2%) were aged 65-79 years. The treatment completion, mortality rates and treatment delay were 54.8%, 34.7% and 61 (12-128) [median, (1st-3rd quartiles)] days in patients aged ≥80 years, 68.3%, 18.5% and 53 (8-122) days in patients aged 65-79 years, and 78.9%, 6.5% and 21 (1-84) days in patients aged <65 years, respectively. The elder patients were more likely to receive second-line anti-tuberculosis agents. The treatment completion rate decreased with older age, female sex, comorbidities, low income, requiring second-line anti-tuberculosis agents, severity of pulmonary tuberculosis and longer treatment delay. Older age, female sex, comorbidities, low income, and not undergoing rapid molecular diagnostic tests were independently associated with longer treatment delays. Conclusions: Pulmonary tuberculosis in advanced age has a longer treatment delay and a higher mortality rate. Applying rapid molecular diagnostic tools may reduce treatment delay and should be integrated into the diagnostic algorithm for pulmonary tuberculosis, particularly in elderly patients.

Original languageEnglish
Article number449
JournalBMC Infectious Diseases
Volume17
Issue number1
DOIs
Publication statusPublished - Jun 24 2017

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Fatal Outcome
Pulmonary Tuberculosis
Cohort Studies
Therapeutics
Molecular Pathology
Mortality
Comorbidity
Tuberculosis
National Health Programs
Taiwan
Routine Diagnostic Tests
Databases

Keywords

  • Clinical epidemiology
  • Clinical respiratory medicine
  • Infection and inflammation
  • Tuberculosis

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

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title = "Treatment delay and fatal outcomes of pulmonary tuberculosis in advanced age: A retrospective nationwide cohort study",
abstract = "Background and objective: Studies focusing on pulmonary tuberculosis in advanced age (≥80 years) are lacking. This study aimed to explore treatment delay, outcomes and their predictors in this group. Methods: Adult (≥20 years) patients with pulmonary tuberculosis were identified from the National Health Insurance Research Database of Taiwan from 2004 to 2009. Treatment completion and mortality rates were noted at one year after treatment. Results: Among the 81,081 patients with pulmonary tuberculosis identified, 13,923 (17.2{\%}) were aged ≥80 years, and 26,897 (33.2{\%}) were aged 65-79 years. The treatment completion, mortality rates and treatment delay were 54.8{\%}, 34.7{\%} and 61 (12-128) [median, (1st-3rd quartiles)] days in patients aged ≥80 years, 68.3{\%}, 18.5{\%} and 53 (8-122) days in patients aged 65-79 years, and 78.9{\%}, 6.5{\%} and 21 (1-84) days in patients aged <65 years, respectively. The elder patients were more likely to receive second-line anti-tuberculosis agents. The treatment completion rate decreased with older age, female sex, comorbidities, low income, requiring second-line anti-tuberculosis agents, severity of pulmonary tuberculosis and longer treatment delay. Older age, female sex, comorbidities, low income, and not undergoing rapid molecular diagnostic tests were independently associated with longer treatment delays. Conclusions: Pulmonary tuberculosis in advanced age has a longer treatment delay and a higher mortality rate. Applying rapid molecular diagnostic tools may reduce treatment delay and should be integrated into the diagnostic algorithm for pulmonary tuberculosis, particularly in elderly patients.",
keywords = "Clinical epidemiology, Clinical respiratory medicine, Infection and inflammation, Tuberculosis",
author = "Lee, {Chih Hsin} and Wang, {Jann Yuan} and Lin, {Hsien Chun} and Lin, {Pai Yang} and Chang, {Jer Hwa} and Suk, {Chi Won} and Lee, {Li Na} and Lan, {Chou Chin} and Bai, {Kuan Jen}",
year = "2017",
month = "6",
day = "24",
doi = "10.1186/s12879-017-2554-y",
language = "English",
volume = "17",
journal = "BMC Infectious Diseases",
issn = "1471-2334",
publisher = "BioMed Central",
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TY - JOUR

T1 - Treatment delay and fatal outcomes of pulmonary tuberculosis in advanced age

T2 - A retrospective nationwide cohort study

AU - Lee, Chih Hsin

AU - Wang, Jann Yuan

AU - Lin, Hsien Chun

AU - Lin, Pai Yang

AU - Chang, Jer Hwa

AU - Suk, Chi Won

AU - Lee, Li Na

AU - Lan, Chou Chin

AU - Bai, Kuan Jen

PY - 2017/6/24

Y1 - 2017/6/24

N2 - Background and objective: Studies focusing on pulmonary tuberculosis in advanced age (≥80 years) are lacking. This study aimed to explore treatment delay, outcomes and their predictors in this group. Methods: Adult (≥20 years) patients with pulmonary tuberculosis were identified from the National Health Insurance Research Database of Taiwan from 2004 to 2009. Treatment completion and mortality rates were noted at one year after treatment. Results: Among the 81,081 patients with pulmonary tuberculosis identified, 13,923 (17.2%) were aged ≥80 years, and 26,897 (33.2%) were aged 65-79 years. The treatment completion, mortality rates and treatment delay were 54.8%, 34.7% and 61 (12-128) [median, (1st-3rd quartiles)] days in patients aged ≥80 years, 68.3%, 18.5% and 53 (8-122) days in patients aged 65-79 years, and 78.9%, 6.5% and 21 (1-84) days in patients aged <65 years, respectively. The elder patients were more likely to receive second-line anti-tuberculosis agents. The treatment completion rate decreased with older age, female sex, comorbidities, low income, requiring second-line anti-tuberculosis agents, severity of pulmonary tuberculosis and longer treatment delay. Older age, female sex, comorbidities, low income, and not undergoing rapid molecular diagnostic tests were independently associated with longer treatment delays. Conclusions: Pulmonary tuberculosis in advanced age has a longer treatment delay and a higher mortality rate. Applying rapid molecular diagnostic tools may reduce treatment delay and should be integrated into the diagnostic algorithm for pulmonary tuberculosis, particularly in elderly patients.

AB - Background and objective: Studies focusing on pulmonary tuberculosis in advanced age (≥80 years) are lacking. This study aimed to explore treatment delay, outcomes and their predictors in this group. Methods: Adult (≥20 years) patients with pulmonary tuberculosis were identified from the National Health Insurance Research Database of Taiwan from 2004 to 2009. Treatment completion and mortality rates were noted at one year after treatment. Results: Among the 81,081 patients with pulmonary tuberculosis identified, 13,923 (17.2%) were aged ≥80 years, and 26,897 (33.2%) were aged 65-79 years. The treatment completion, mortality rates and treatment delay were 54.8%, 34.7% and 61 (12-128) [median, (1st-3rd quartiles)] days in patients aged ≥80 years, 68.3%, 18.5% and 53 (8-122) days in patients aged 65-79 years, and 78.9%, 6.5% and 21 (1-84) days in patients aged <65 years, respectively. The elder patients were more likely to receive second-line anti-tuberculosis agents. The treatment completion rate decreased with older age, female sex, comorbidities, low income, requiring second-line anti-tuberculosis agents, severity of pulmonary tuberculosis and longer treatment delay. Older age, female sex, comorbidities, low income, and not undergoing rapid molecular diagnostic tests were independently associated with longer treatment delays. Conclusions: Pulmonary tuberculosis in advanced age has a longer treatment delay and a higher mortality rate. Applying rapid molecular diagnostic tools may reduce treatment delay and should be integrated into the diagnostic algorithm for pulmonary tuberculosis, particularly in elderly patients.

KW - Clinical epidemiology

KW - Clinical respiratory medicine

KW - Infection and inflammation

KW - Tuberculosis

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U2 - 10.1186/s12879-017-2554-y

DO - 10.1186/s12879-017-2554-y

M3 - Article

C2 - 28646854

AN - SCOPUS:85021209552

VL - 17

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

SN - 1471-2334

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M1 - 449

ER -