Sociodemographic and Clinical Factors Associated with Tuberculosis Mortality in Hamadan Province, Iran

TL;DR

This study identifies factors linked to tuberculosis mortality in Iran's Hamadan province, highlighting the need for targeted interventions to reduce deaths.

Contribution

The study provides region-specific insights into sociodemographic and clinical factors influencing TB mortality in Hamadan, Iran.

Findings

Smear-positive pulmonary TB patients had the highest mortality risk, with positive sputum smear at month 2 strongly associated with death.

Extrapulmonary TB patients had significantly lower odds of death compared to smear-positive pulmonary TB patients.

HIV positivity increased mortality risk in smear-negative pulmonary TB patients, while male gender and hospitalization were risk factors in extrapulmonary TB patients.

Abstract

Tuberculosis (TB) remains a global health concern with high mortality despite treatment options. Understanding the underlying risk factors for TB mortality is essential for guiding effective control strategies. This study examined sociodemographic and clinical factors related to TB mortality in Hamadan province, Iran, to inform control strategies.

A cross-sectional study.

This study evaluated data (March 2011–March 2022) obtained from a provincial TB surveillance database, encompassing smear-positive pulmonary TB (SPT), smear-negative pulmonary TB (SNT), and extrapulmonary TB (EPT) patients. Demographic and clinical characteristics were investigated, and the death rate for each group was calculated by dividing the number of TB-related deaths by the total number of diagnosed TB cases for that group during the study period. Logistic regression was applied to computed unadjusted and adjusted odds ratios (ORs) with a 95% confidence interval for the death rate using Stata 17 (P<0.05).

Among the 942 patients included in the study, 49%, 21%, and 30% were diagnosed with SPT, SNT, and EPT, respectively. The risk of mortality was the highest among SPT patients, with EPT cases showing significantly lower odds of death (OR: 0.38, P<0.001) compared to SPT. Among SPT patients, mortality was associated with older age (OR: 1.04, P<0.001) and positive sputum smear at month 2 (OR: 19.72, P<0.001). Human immunodeficiency virus (HIV) positivity significantly increased the death rate in SNT patients (P=0.037). In EPT patients, mortality was linked to male gender (P=0.042), referral unit (P=0.023), TB hospitalization (P=0.018), and advanced age (P<0.001).

Targeted interventions focusing on early diagnosis, HIV management, and care for high-risk groups (e.g., elderly) are essential to reduce TB mortality in Hamadan province. However, the findings should be interpreted with caution due to limitations, such as reliance on retrospective registry data, potential information bias, and missing data, particularly regarding HIV status.