Impact of Multimorbidity Subgroups on the Health Care Use and Clinical Outcomes of Patients With Tuberculosis: A Population-Based Cohort Analysis

Abstract

Background: Multimorbidity is defined as the existence of two or more chronic health conditions in the same individual. While patients with tuberculosis commonly have multiple conditions at diagnosis, such as HIV, diabetes, and depression, to the authors' knowledge, there is limited information on the patterns of multimorbidity, and how the types and combinations of conditions could impact the healthcare utilization, expenditure, and TB outcomes.Methods: An observational cohort study of adult patients diagnosed with tuberculosis was conducted using the Chinese Center for Disease Control and Prevention (CDC)'s National TB Information System (NTBIS) linked to the Ningbo Regional Health Care Database (NRHCD) (2015–2020). Latent class analysis was used to identify comorbidity groups among the subset with ≥2 conditions including TB. Group-level health care use, expenditure, and treatment outcomes were compared with patients without chronic conditions using multivariate regression models.Results: A total of 9,651 patients with TB were identified, of whom approximately 61.4% had no chronic conditions, 17.4% had 1 chronic condition, and 21.3% had ≥2 chronic conditions. Among those with ≥1 chronic condition other than TB, 4 groups emerged: (1) general morbidity (54.4%); (2) cardiovascular morbidity without complications (34.7%); (3) cardiovascular morbidity with complications (5.0%); (4) respiratory morbidity (5.9%). The respiratory morbidity group experienced the highest expenditures, at 16,360 CNY more overall (95% CI, CNY 12,615–21,215) after adjustment compared with TB patients without chronic conditions. The respiratory morbidity and cardiovascular morbidity with complications group also had the lowest odds of favorable TB outcomes [adjusted odds ratio (aOR), 0.68; 95% CI, 0.49–0.93] and (aOR 0.59, 95% CI 0.42–0.83), respectively. The cardiovascular morbidity without complications group had the highest odds of successful TB treatment (aOR, 1.40; 95% CI, 1.15–1.71).Conclusions: Multimorbidity is common among patients with TB. The current study identified four distinct comorbidity subgroups, all of which experienced high, yet differential, rates of health care use. These findings highlight the need for urgent reforms to transform current fragmented TB care delivery and improve access to other specialists and financial assistance.

Landscaping tuberculosis multimorbidity: findings from a cross-sectional study in India

“…Our study found a 52% prevalence of multimorbidity and 30.6% prevalence of more than two chronic conditions among TB patients. Similar to our findings, Chen et al in their study in China observed 38.6% and 21.2% whereas Karl et al in South Africa reported 26.9% and 25.3% prevalence of multimorbidity and two or more chronic conditions respectively among TB patients [ 9 , 18 ]. This suggest multimorbidity to be a norm rather than exception among TB patients, especially among the high TB burden countries in the world.…”

“…TB multimorbidity may represent a substantial burden for individuals, increasing their risk of adverse events and unfavorable outcomes ultimately affecting the already constrained healthcare system [ 9 ]. It poses a primary concern for healthcare system in India which is typically focused to manage single conditions [ 10 ].…”

Prevalence and risks of tuberculosis multimorbidity in low-income and middle-income countries: a meta-review

“…In addition to the gaps in the literature with regards to primary studies, our meta-review also highlights the lack of systematic reviews focused on people with TB and more than one additional chronic condition, which is an increasingly likely scenario as the prevalence of NCDs in LMICs grows. 2 In this regard, several cohort studies have assessed the impact of multimorbidity on TB treatment outcomes, such as in China or Brazil 31 32 finding worse outcomes among patients with multiple additional chronic conditions. Furthermore, Chen et al’s 31 results highlight that some combinations of comorbidities, such as the group with cardiovascular morbidity with complications, increase the risk of negative TB treatment outcomes more than others.…”

“… 2 In this regard, several cohort studies have assessed the impact of multimorbidity on TB treatment outcomes, such as in China or Brazil 31 32 finding worse outcomes among patients with multiple additional chronic conditions. Furthermore, Chen et al’s 31 results highlight that some combinations of comorbidities, such as the group with cardiovascular morbidity with complications, increase the risk of negative TB treatment outcomes more than others. Considering the potential multiple-way synergies between multiple chronic conditions, a systematic review of the literature on this topic is sorely needed.…”

Risk of peripheral facial palsy following parenteral inactivated influenza vaccination in the elderly Chinese population

“…The Ningbo Regional Health Care Database (NRHCD), a standardized medical information network in Ningbo, China, collects and integrates electronic health records from hospitals and community clinics in the jurisdiction. In 2016, the platform reached the top level in the regional health information interconnection standardization and maturity measurement of the National Health Commission (18)(19)(20). By 2019, the platform covered all 65 public hospitals and 154 primary medical institutions.…”