Influence of demographic, medical and seasonal factors on mortality among tuberculosis patients

  Published: 05.01.09 Updated: 05.01.2009 16:23:07
Glumnaya T. Influence of demographic, medical and seasonal factors on mortality among tuberculosis patients [thesis synopsis]. Moscow: Central Scientific-Research Institute of tuberculosis; 2008.

According to the information from the Higher Attestation Commission, T. V. Glumnaya defended her doctoral thesis on 10 June 2008. The title of the thesis was “Influence of demographic, medical and seasonal factors on mortality among tuberculosis patients”. The purpose of the study was to investigate the influence of certain demographic, medical, seasonal, and ecological factors on mortality among tuberculosis patients and to study trends and structure of mortality from tuberculosis and other diseases in the Voronezh region in 1980-2006. Other aims included assessment of the relationship between the quality of measures directed to active detection and dispensary monitoring of tuberculosis patients and the outcomes of the disease; prediction of mortality based on the combined influence of various factors and development of specific measures directed at decrease in mortality among tuberculosis patients.

The author concludes that mortality from tuberculosis reflects epidemiological situation only if there is a systematic surveillance of tuberculosis and control measures in place. If there is no surveillance and dispensary monitoring, the number deaths with tuberculosis as a main cause can be overestimated by 9-16%. The highest mortality among tuberculosis patients is registered among 40-44 and 45-49 years old men (22.9 and 23.6 per 100,000, respectively). Mortality from tuberculosis among men is highest in the age group 40-44 years (46.4 per 100,000) and among women in the age group 30-39 years (4.1 per 100,000) resulting in male-female ratio of 13.1/1. Altogether, 50.2% of the tuberculosis patients die from other causes.

The author also reports that lethality among patients with disseminated forms of tuberculosis with destruction and bacteria production is 73.5%. Lethality in patients without disseminated forms and without destruction and bacteria production is 19.5%. Lethality is higher among patients who sought medical help compared to those who were actively diagnosed on regular check-ups. The outcome of tuberculosis depends on the patient’s social status: lethality was 4.4 times higher among socially deprived patients.  The author concludes that adequate treatment is the main factor that prevents death from tuberculosis and that 83.1% of the tuberculosis patients can be cured. Multivariate analysis of lethality showed that pulmonary tissue destruction, bacteria production, multidrug resistance and patient’s attitude to treatment are the major predictors of lethality from tuberculosis.

The author predicts that if the current trends in socio-economic development, amount and quality of tuberculosis treatment will remain the same, the mortality from tuberculosis will decrease by 10-15% within a few years and stabilize afterwards. The author calculated that the total costs of cured patient were three times lower than costs to monitor and treat the patient who died. Prevention of one death from tuberculosis saves on average 730-750 thousand rubles (25-26 thousand US dollars).

The full text of the thesis synopsis in Russian is available here.