Prevalence and risk factors associated with tuberculosis mortality in Brunei Darussalam

Abstract

Objective: To determine the prevalence and risk factors associated with tuberculosis mortality in Brunei Darussalam and to explore its underlying causes. Methods: A retrospective cohort study was conducted where data on socio-demographics, clinical characteristics and treatment outcomes of all tuberculosis patients registered at the National tuberculosis Coordinating Centre between 2013 and 2017 were collected. Overall tuberculosis mortality and the proportion of tuberculosis-related deaths were calculated. Logistic regression analysis was used to determine the risk factors of tuberculosis mortality when compared to those who are cured and/or completed tuberculosis treatment. Results: Of 1 107 tuberculosis cases, 99 died, giving an overall tuberculosis mortality rate of 8.9% (95% CI 7.4%-10.8%). Significant risk factors associated with tuberculosis mortality were age ≥40 years (adjusted OR for 40-59 years was 3.89; 95% CI 1.13-1.69; adjusted OR for ≥60 years was 22.3; 95% CI 7.27-91.9, using 20-39 years as reference), female sex (adjusted OR 1.74; 95% CI 1.09-2.79), having renal disease (adjusted OR 25.7; 95% CI 2.82-191.50) and having any cancers (adjusted OR 3.61; 95% CI 1.26-10.00). The majority (75.8%) of the recorded deaths were not related to tuberculosis. Conclusions: Tuberculosis patients who were older than 40 years, female, and having renal disease and any cancer will need close monitoring in their management program to prevent tuberculosis mortality. Clinicians should also focus on other non-tuberculosis aspects of the patient’s medical history.

Keywords

Mycobacterium infections / Tuberculosis / Mortality / Brunei

References

[1] World Health Organization. Global tuberculosis report 2021. [Online]. Available from:https://www.who.int/publications/i/item/9789240037021. [Accessed on 12 January 2021].

[2] Xie Y, Han J, Yu W, Wu J, Li X, Chen H. Survival analysis of risk factors for mortality in a cohort of patients with tuberculosis. Can Respir J 2020; 2020:1654653. doi: 10.1155/2020/1654653.

[3] Liu Y, Zheng Y, Chen J, Shi Y, Shan LY, Wang S, et al. Tuberculosis-associated mortality and its risk factors in a district of Shanghai, China: A retrospective cohort study. Int J Tuberc Lung Dis 2018; 22(6):655-660.

[4] Avoi R, Liaw YC. Tuberculosis death epidemiology and its associated risk factors in Sabah, Malaysia. Int J Environ Res Public Health 2021; 18(18). doi:10.3390/ijerph18189740.

[5] Lin CH, Lin CJ, Kuo YW, Wang JY, Hsu CL, Chen JM, et al. Tuberculosis mortality: Patient characteristics and causes. BMC Infect Dis 2014; 14(1):5.

[6] Gaifer Z. Risk factors for tuberculosis mortality in a tertiary care center in Oman, 2006-2016. Int J Mycobacteriol 2017; 6(4):356.

[7] Hannah HA, Miramontes R, Gandhi NR. Sociodemographic and clinical risk factors associated with tuberculosis mortality in the United States, 2009-2013. Public Health Rep 2017; 132(3):366-375.

[8] Zerbini E, Greco A, Estrada S, Cisneros M, Colombo C, Beltrame S, et al. Risk factors associated with tuberculosis mortality in adults in six provinces of Argentina. Medicina (B Aires) 2017; 77(4):267-273.

[9] World Health Organization. Definitions and reporting framework for tuberculosis-2013 revision (Updated December 2014 and January 2020). [Online]. Available from:https://www.who.int/publications/i/item/9789241505345. [Accessed on 12 January 2021].

[10] World Health Organization. Country factsheet: Public health data at a glance-Brunei Darussalam. [Online]. Available from:https://www.who.int/docs/default-source/wpro---documents/countries/brunei-darussalam/fact-sheet-brunei-darussalam.pdf?sfvrsn=b91eddf4_5. [Accessed on 1 April 2021].

[11] Chaw L, Abdul Hamid R, Koh KS,Thu K. Contact investigation of tuberculosis in Brunei Darussalam: Evaluation and risk factor analysis. BMJ Open Respir Res 2022; 9(1):e001224.

[12] Ministry of Health Brunei Darussalam. Guidelines for tuberculosis control in Brunei Darussalam. [Online]. Available from:http://www.moh.gov.bn/SitePages/Downloads.aspx. [Accessed on 1 April 2021].

[13] Ministry of Health Brunei Darussalam. Health information booklet 2017 (second revision). 2019. [Online]. Available from:http://moh.gov.bn/SitePages/Health Information Booklet.aspx. [Accessed on 11 February 2020].

[14] Ministry of Health Brunei. Bru-HIMS. 2020. [Online]. Available from:https://www.moh.gov.bn/SitePages/Bru-HIMS.aspx. [Accessed on 1 October 2020].

[15] Laws of Brunei. Chapter 17. Immigration. [Online]. Available from:https://www.ilo.org/wcmsp5/groups/public/@ed_protect/@protrav/@ilo_aids/documents/legaldocument/wcms_117279.pdf. [Accessed on 12 January 2021].

[16] R Core Team. R: A language and environment for statistical computing. 2021. [Online]. Available from:http://www.r-project.org/. [Accessed on 12 January 2021].

[17] Shen X, DeRiemer K, Yuan Z, Shen M, Xia Z, Gui X, et al. Deaths among tuberculosis cases in Shanghai, China: Who is at risk? BMC Infect Dis 2009; 9(1):95.

[18] Chung SY, Seon JY, Lee SH, Kim HY, Lee YW, Bae K, et al. The relationship between socio-demographic factors and tuberculosis mortality in the Republic of Korea during 2008-2017. Front Public Heal 2021; 9:1-9.

[19] Choi H, Han K, Jung JH, Park SH, Kim SH, Kang HK, et al. Long-term mortality of tuberculosis survivors in Korea: A population-based longitudinal study. Clin Infect Dis 2022; doi: 10.1093/cid/ciac411.

[20] Heunis JC, Kigozi NG, Chikobvu P, Botha S, van Rensburg HCJD. Risk factors for mortality in TB patients: A 10-year electronic record review in a South African province. BMC Public Health 2017; 17(1):38.

[21] Lim CY, Tan J. Global dialysis perspective: Brunei Darussalam. Kidney 360 2021; 2(6):1027-1030.