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PLoS One. 2014 Jul 8;9(7):e100082. doi: 10.1371/journal.pone.0100082. eCollection 2014.

Treatment outcomes in tuberculosis patients with diabetes: a polytomous analysis using Brazilian surveillance system.

Author information

1
Lab-Epi UFES Laboratory of Epidemiology of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil; Post-Graduate Programme in Epidemiology, Universidade Federal de Pelotas, Rio Grande do Sul, Brazil.
2
Lab-Epi UFES Laboratory of Epidemiology of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.
3
Post-Graduate Programme in Saúde Coletiva, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.
4
Department of Public Health, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Brazil.
5
Post-Graduate Programme in Epidemiology, Universidade Federal de Pelotas, Rio Grande do Sul, Brazil.
6
Division of Infectious Disease and Vaccinology, School of Public Health, University of California, Berkeley, California, United States of America.
7
Lab-Epi UFES Laboratory of Epidemiology of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil; Post-Graduate Programme in Saúde Coletiva, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.

Abstract

BACKGROUND:

The impact of non-communicable diseases on tuberculosis incidence has received significant attention. It has been suggested that the risk of tuberculosis is higher among subjects with diabetes and these subjects also has poor TB treatment outcomes.This study was aimed at assessing the socio-demographic and clinical factors that may influence different outcome of TB in patients with DM (TB-DM) identified in the Brazilian national database from 2001 to 2011.

METHODS:

TB-DM cases reported in the Brazilian information system were identified and compared.Covariates associated with the outcomes of interest (cure, default, deaths, and development of TB MDR) were included in a hierarchical regression model.

RESULTS:

TB-DM cases increased from 380/100,000/year in 2001 to 6,150/100,000/year in 2011. Some of the main associations found are pointed. The odds of default was higher among those in the age group 20-39 years (OR = 2.07, 95%CI 1.32-3.24); alcoholics (OR = 2.17, 95%CI 1.86-2.54), and HIV/AIDS (OR = 2.16, 95%CI 1.70-2.74);positive monitoring smear (OR = 1.94, 95%CI 1.55-2.43); prior default (OR = 5.41, 95%CI 4.47-6.54), and unknown type of treatment (OR = 3.33, 95%CI 1.54-7.22). The odds of death was greater for subjects ≥60 years old (OR = 2.74, 95%CI 1.74-4.29); institutionalized in shelter (OR = 2.69, 95%CI 1.07-6.77); alcoholics (OR = 2.70, 95%CI 2.27-3.22); HIV/AIDS (OR = 2.87, 95%CI 2.13-3.86); pulmonary+extrapulmonary TB (OR = 2.49, 95%CI 1.79-3.46); with unknown type of treatment (OR = 14.12, 95%CI 7.04-28.32).Development of MDR TB was more related to relapse (OR = 9.60, 95%CI 6.07-15.14);previous default (OR = 17.13, 95%CI 9.58-30.63); and transfer of treatment center (OR = 7.87, 95%CI 4.74-13.07).

CONCLUSIONS:

Older subjects and those with comorbidities and with a previous treatment of TB had poorest outcomes. TB control program in Brazil will need to expand efforts to focus on treatment of TB-DM patients to improve their cure rates in order to achieve the goals of tuberculosis elimination.

PMID:
25003346
PMCID:
PMC4086729
DOI:
10.1371/journal.pone.0100082
[Indexed for MEDLINE]
Free PMC Article

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