Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia

Abstract

Background Patients with a history of tuberculosis (TB) have a high probability of recurrence because long-term cure is not always maintained in successfully treated patients. The aim of this study was to identify the probability of TB recurrence and its predictive factors in a cohort of socially vulnerable patients who completed treatment in the TB referral center in Catalonia, which acts as the center for patients with social and health problems. Methods This retrospective open cohort study included all patients diagnosed with TB who were admitted and successfully treated in Serveis Clínics between 2000 and 2016 and who remained disease-free for a minimum of 1 year after treatment completion. We calculated the incidence density of TB recurrences per person-years of follow-up. We also estimated the cumulative incidence of TB recurrence at 1, 2, 5, and 10 years of follow-up. Bivariate analysis was conducted using Kaplan-Meier curves. Multivariate analysis was conducted using Cox regression. Hazard ratios (HR) were calculated with their 95% confidence intervals (95%CI). Results There were 839 patients and 24 recurrences (2.9%), representing 0.49 per 100 personyears. The probability of a recurrence was 0.63% at 1 year of follow-up, 1.35% at 2 years, and 3.69% at 5 years. The multivariate analysis showed that the predictive factors of recurrence were age older than 34 years (aHR = 3.90; CI = 1.06-14.34 at age 35-45 years and aHR = 3.88; CI = 1.02-14.80 at age >45 years) and resistance to at least one anti-TB drug (aHR = 2.91; CI = 1.11-7.65).

Tuberculosis recurrence over a 7-year follow-up period in successfully treated patients in a routine program setting in China: a prospective longitudinal study

“…36 However, a recent study in Spain showed that smoking was not a predictive factor for recurrence. 39 Exact reasons of these homogeneous results need to be further studied, and could be to the different definitions of smoking status used. In contrary to our study, the definition used in the Spain study was persons who smoke any number of cigarettes every day during the past month.…”

Recurrence Rate of Pulmonary Tuberculosis in Patients Treated with the Standard 6-Month Regimen: Findings and Implications from a Prospective Observational Multicenter Study

“…The recurrence of TB following successful treatment is considered one of the main challenges posed to TB control in many countries. It is evident that even after successfully treating this infectious disease, individuals with a previous history of TB infection are at a higher risk of recurrent TB [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Moreover, the rate of TB recurrence differs widely among countries and regions [ 13 ].…”

The burden of alcohol, tobacco and others drugs among incarcerated population diagnosed with tuberculosis: time trends and spatial determinants in Southern Brazil

“…Even though the TB burden declined in recent years before the COVID-19 pandemic [ 3 ], it is a disease difficult to control and eliminate due to co-infection with human immunodeficiency virus (HIV); antimicrobial resistance; multidrug-resistant TB; and increased consumption of alcohol, tobacco, and/or other drugs. In addition, TB is associated with social determinants of health, such as social vulnerability, poverty, and social exclusion to which populations such as immigrants, refugees, the homeless, and the incarcerated population are exposed [ 4 ]. It is estimated that 90% of the patients diagnosed with TB live in vulnerable environments with limited health resources [ 5 ], such as individuals living in correctional facilities.…”