As TB cases decline, patients have become more complex
As cases of tuberculosis have declined in California, patients with TB have become more complex to treat, researchers reported in Open Forum Infectious Diseases.
“The study was done because TB practitioners noted, anecdotally, that the complexity of cases with TB was rising in recent years despite the fall in total numbers of cases,” Alon Vaisman, MD, of the department of medicine at the University of Toronto, told Healio. “This was likely also true in other jurisdictions in North American with similar demographics — aging populations with more comorbidities, polypharmacy, and more frequent immunosuppressive conditions. Therefore, we wanted a formal way of defining this complexity and determining whether it was rising.”
Vaisman and colleagues analyzed data on patient comorbidities, clinical features and demographics from the California Department of Public Health TB Registry, including all adult patients who were alive at the time of TB diagnosis in California during 1993-2016. According to the study, the researchers then analyzed factors determined by an expert panel to increase complexity, included older age, HIV infection, multidrug resistance (MDR) and extrapulmonary TB disease.
Among 67,512 patients, the proportion of patients having extrapulmonary disease or MDR-TB or being aged older than 75 years increased over the study period, whereas the proportion of patients with HIV decreased. The study showed that the proportion of patients with at least one of those factors increased from 38.8% in 1993 to 45.3% in 2016.
According to the study, an analysis showed explanatory factors that included that race and/or immigration status, being elderly and/or institutionalized, and having advanced TB.
“TB programs across the United States require ongoing funding to maintain a high level [of] care,” Vaisman concluded. “The temptation may now be to reduce funding to TB programs due to the falling numbers. However, because each patient is now more complicated than before, practitioners will need extra resources — communication, nursing, time investment — to successfully treat these patients.”