1451. Tuberculosis among Adults Aged 65 Years and Older—Alameda County, California, 2016–2019

Abstract

Background Adults aged 65 years and older represent an increasing proportion of United States (U.S.) tuberculosis (TB) cases, and their clinical complexity creates unique issues for TB management. In Alameda County, California, we examined clinical characteristics and treatment outcomes among older adults with TB disease. Methods We evaluated demographic and clinical surveillance data from all adult TB cases in Alameda County during 2016–2019. We further reviewed public health department charts for TB cases among individuals aged 65 years and older to obtain more detailed information on co-morbidities, adverse effects, and treatment outcomes. Demographics, clinical characteristics, and outcomes were compared in younger adults (15-64) to older adults (≥ 65), who were further stratified by those aged 75 years and older. All comparisons were conducted using Fisher’s exact or Mann-Whitney U tests. Results Of 517 adult TB cases, 172 (33%) were older adults, and more likely to be male (68.6%), Asian (89.0%), non-U.S. born (98.3%), and have diabetes (32.6%) compared to younger adults (Table). At time of TB diagnosis, older adults were more likely than younger adults to have a negative interferon-gamma release assay result (24.6% vs. 16.0%, P=0.01), particularly among aged 75 years and older where 32.9% had a negative result. The majority of older adults with pulmonary TB had sputum smear-negative disease (58.9%) and 19.9% were culture- and polymerase chain reaction assay-negative. On anti-TB treatment, 32.5% of older adults experienced at least one adverse event, most commonly elevated liver enzymes (56.6%) and rash (32.1%). Older adults were more likely to be dead at diagnosis (3.5% vs. 0.0%, P=0.001), and were less likely to complete TB treatment (77.7% vs. 88.4% in younger adults, P=0.002), which was lowest among aged 75 years and older (72.9% vs. 84.3% in those 65-74, P=0.04). Death during treatment was higher in older adults, in particular aged 75 and older compared to 65–74 years (22.9% vs. 7.1%, P=0.01). Conclusion Older adults with TB disease faced several challenges, including negative diagnostic testing and poor treatment outcomes. A greater understanding of the presentation, adverse events and outcomes can guide interventions to improve TB care in this population. Disclosures All Authors: No reported disclosures.