Tuberculosis is treatable and curable, but newly published study findings showed that patients treated for — or cured of — TB still experience significantly increased mortality following treatment, with a pooled standardized mortality ratio, or SMO, nearly three times higher than the general population or matched controls, according to results from a systematic review and meta-analysis published in The Lancet Infectious Diseases.
Around 20% of post-treatment deaths were attributed to cardiovascular disease or cancer, researchers reported.
“WHO estimates that, in 2017, more than 10 million people were affected by tuberculosis, resulting in an estimated 1.6 million deaths. These WHO mortality data estimate the number of people with tuberculosis who die before starting or during tuberculosis treatment irrespective of cause of death,” James C. Johnston, MD, a TB physician and researcher at the British Columbia CDC, and colleagues wrote.
“However, the routine reporting upon which WHO estimates are based does not capture mortality in the post-treatment period. Consequently, accurate programmatic estimates of mortality following tuberculosis treatment are unavailable.”
For their study, Johnston and colleagues searched Embase, MEDLINE and the Cochrane Database of Systematic Reviews for studies published between Jan 1, 1997, and May 31, 2018. They restricted their search to papers “that used a cohort study design, included bacteriological or clinical confirmation of TB disease for all participants, and reported, or provided enough data to calculate mortality estimates for people with TB and a valid control group representative of the general population.”
According to Johnston and colleagues, they included data from 10 studies with 40,781 patients and 6,922 deaths in their analysis and found that the SMR for all-cause mortality among patients with TB compared with controls was 2.91 (95% CI 2.21-3.84; I² = 99%). It rose to 3.76 (95% CI 3.04-4.66; I² = 95%) when they restricted the data to people with confirmed treatment completion or cure.
“People treated for tuberculosis, as a group, are at high risk of premature death after treatment. These individuals frequently have negative health effects after treatment, in addition to lower socioeconomic status and more comorbidities than the general population,” the authors concluded. “Further research investigating the pathways linking both medical and social factors to long-term mortality among this population is needed. Improved characterization of the factors contributing to the excess mortality in people treated for tuberculosis could bolster the case for more comprehensive socioeconomic and medical interventions, which promise to have a substantial effect on the long-term prognosis and survival of this population.” – by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.