Pulmonary Tuberculosis Mortality and Its Risk Factors Among Patients With Type 2 Diabetes And Pulmonary Tuberculosis In Four Community Hospitals, Central Thailand

Tuberculosis (TB), a communicable disease, is currently a significant health problem in Thailand. Type 2 diabetes (T2D) is an indicator of poor TB outcomes; however, data according to specific antihyperglycemic use and tuberculosis outcomes in community hospital settings in Thailand remain limited. We aimed to determine TB mortality as well as explore the demographic and clinical risk factors among patients with pulmonary TB and underlying T2D. A retrospective cohort study was conducted between January 1, 2013, and December 31, 2020, to determine tuberculosis mortality and its risk factors among patients with T2D and pulmonary TB visiting three community hospitals, in central Thailand. T2D and pulmonary TB were determined according to the International Classification of Diseases, Tenth Revision codes presented in medical records. TB mortality data were reviewed and retrieved from the tuberculosis treatment cards. Patients were classified as “dead” when they died before completing treatment regardless of the causes. Multivariable cox proportional regression analysis was performed to obtain the adjusted hazard ratios (AHR) and 95% confidence interval (CI) of factors related to TB mortality. A total of 133 patients with T2D and pulmonary TB were enrolled in the present study; 74 (55.6%) participants were males. At baseline, the average age of participants was 57.29+12.51 years. During the study period, the TB mortality rate was 15.74 (95% CI 8.13-27.50) deaths per 100 person-years. The independent risk factors for TB mortality included age ≥70 years (AHR 5.45, 95% CI; 1.36-21.84), use of insulin (AHR 4.62, 95% CI; 1.11-19.21), and positive sputum test result at 1st follow-up (AHR 16.10, 95% CI; 2.10-123.40). TB mortality among patients with T2D should be emphasized. Insulin use may be a proxy indicator for poor glycemic control associated with mortality. Additionally, elderly patients should be closely observed for successful treatment as well as monitoring for any adverse events.