Directly observed therapy reduces tuberculosis-specific mortality: a population-based follow-up study in Taipei, Taiwan

• Published in: PloS one 2013-11, Vol.8 (11), p.e79644-e79644
• Main Authors: Yen, Yung-Feng, Yen, Muh-Yong, Lin, Yi-Ping, Shih, Hsiu-Chen, Li, Lan-Huei, Chou, Pesus, Deng, Chung-Yeh
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Adults; Aged; Antitubercular Agents - therapeutic use; Bacilli; Chest; Chronic kidney failure; Clinical outcomes; Dialysis; Directly Observed Therapy - methods; Disease control; Disease prevention; Drug resistance; End-stage renal disease; Female; Health aspects; Hospitals; Humans; Infectious diseases; Kidney diseases; Kidney transplantation; Lungs; Male; Malignancy; Medical diagnosis; Medical research; Middle Aged; Mortality; Patient compliance; Patients; Pleural effusion; Population studies; Population-based studies; Prognosis; Public health; Radiography; Retrospective Studies; Risk analysis; Risk factors; Smear; Socioeconomic Factors; Sputum; Statistics; Success; Taiwan; Therapy; Treatment Outcome; Tuberculosis; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - mortality; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0079644

To determine the effect of directly observed therapy (DOT) on tuberculosis-specific mortality and non-TB-specific mortality and identify prognostic factors associated with mortality among adults with culture-positive pulmonary TB (PTB). All adult Taiwanese with PTB in Taipei, Taiwan were included in a retrospective cohort study in 2006-2010. Backward stepwise multinomial logistic regression was used to identify risk factors associated with each mortality outcome. Mean age of the 3,487 patients was 64.2 years and 70.4% were male. Among 2471 patients on DOT, 4.2% (105) died of TB-specific causes and 15.4% (381) died of non-TB-specific causes. Among 1016 patients on SAT, 4.4% (45) died of TB-specific causes and 11.8% (120) died of non-TB-specific causes. , After adjustment for potential confounders, the odds ratio for TB-specific mortality was 0.45 (95% CI: 0.30-0.69) among patients treated with DOT as compared with those on self-administered treatment. Independent predictors of TB-specific and non-TB-specific mortality included older age (ie, 65-79 and ≥80 years vs. 18-49 years), being unemployed, a positive sputum smear for acid-fast bacilli, and TB notification from a general ward or intensive care unit (reference: outpatient services). Male sex, end-stage renal disease requiring dialysis, malignancy, and pleural effusion on chest radiography were associated with increased risk of non-TB-specific mortality, while presence of lung cavities on chest radiography was associated with lower risk. DOT reduced TB-specific mortality by 55% among patients with PTB, after controlling for confounders. DOT should be given to all TB patients to further reduce TB-specific mortality.