The Prevalence and Risks of Major Co-Morbidities Among Patients with Pulmonary Tuberculosis in China from a Gender and Age Perspective: A Large-Scale Multi-Center Observational Study

Background: Tuberculosis remains a serious and substantial global public health problem today. Pulmonary tuberculosis (PTB) is the most common clinical presentation of TB. In clinical practice, PTB patients have concurrent many types of co-morbidities such as pneumonia, liver disorder, diabetes mellitus, hematological disorder, malnutrition, hemoptysis, etc. This causes the condition of PTB patients complicated. Detecting and treating specific co-morbidities and preventing their development are important for PTB patients. However, the prevalence of most co-morbid conditions in patients with PTB is not well described. Methods: We conducted a large-scale, multi-center, observational study using admission data at 21 hospitals in China from Jan 1, 2011 to Dec 31, 2017, to elucidate and illustrate the prevalence rates of major co-morbidities in inpatients admitted to hospital for pulmonary TB. The 20 specific co-morbidities were selected for analysis in this patient cohort, and stratified the patient cohort according to age and gender. Findings: A total of 355,929 PTB inpatients were included, with a male:female ratio of 1.97 and the median age 47 (IQR:28~62) years old. The prevalence of 20 specific co-morbidities in patients with PTB was analyzed, with pneumonia being the most common co-morbidity. The prevalence of most co-morbidities were higher in males with PTB except thyroid disorders, mental health disorders, etc. The prevalence of defined most co-morbidities in patients with PTB tended to increase with increasing age, although some specific co-morbidities tended to increase initially then decrease with increasing age. Interpretation: Early identification and management of co-morbidities in patients with PTB may positively influence treatment outcomes for PTB patients. Our study, together with future research into co-morbidity trends in non-hospitalized PTB patients, may be useful in determining community based prevalence rates for PTB co-morbidities, thus enhancing diagnostic and therapeutic decision-making, and clinical outcomes in all PTB patients. Funding Statement: Key Project of Chinese National Programs (Grant No. 2015ZX10003001), ‘Beijing Municipal Administration of Hospitals’ Ascent Plan (No. DFL20181601) and Tongzhou District Science and Technology Committee [No.KJ2017CX054]. Declaration of Interests: All the authors declare no conflicts of interest. Ethics Approval Statement: The Ethics Committee of Beijing Chest Hospital, Capital Medical University approved this study with a waiver of informed consent from the patients involved.