Mortality Among Tuberculosis Patients In New York City

OBJECTIVES : To quantify tuberculosis (TB) related mortality among TB patients in New York City (NYC), NY, USA, and identify risk factors associated with TB-related mortality.DESIGN: We performed a retrospective analysis of verified TB patients in NYC, 2004-2013. NYC Office of Vital Statistics death certificate data and TB surveillance data were matched. Death certificate data were used to identify TB-related deaths. Risk factors for TB-related death for US-born and non-US-born populations were evaluated using multivariable logistic regression.RESULTS : Of 8209 TB patients in NYC, 168 (2%) suffered TB-related deaths before or during anti-tuberculosis treatment. Of these, 62% occurred among non-US-born patients, and 38% occurred among US-born patients. Among the latter, TB-related death was associated with increased age (>= 65 vs. 18-44 years, adjusted OR [aOR] 8.27, 95% CI 3.47-19.71), being culture-positive (aOR 6.79, 95% CI 2.10-21.97), and having both pulmonary and extra-pulmonary disease (aOR 5.06, 95% CI 1.91-13.40). The same factors were also significant among non-US-born patients; TB-related death was also associated with male sex (aOR 1.80, 95% CI 1.11-2.91), history of TB disease (aOR 3.16, 95% CI 1.28-7.77), alcohol use (aOR 1.85, 95% CI 1.00-3.43), homelessness (aOR 2.66 95% CI 1.15-6.19), and unknown human immunodeficiency virus status (aOR 3.91, 95% CI 2.43-6.29).CONCLUSION: Different risk factors between the US- and non-US-born populations were identified. Interventions specific to each population may be needed for reducing TB-related mortality.