Treatment outcomes for elderly patients in Thailand with pulmonary tuberculosis

Background: Elderly patients with pulmonary tuberculosis are less likely to achieve treatment success than younger patients, and patients aged >= 60 years have a substantial increase in mortality. Objectives: To compare treatment outcomes over 2 periods during the transition of Thai national tuberculosis (TB) reporting systems and determine treatment success rates and mortality for elderly patients in TB treatment-care settings in Thailand. Methods: Retrospective cohort study of all records of elderly patients extracted from 2 national TB databases in Thailand: the TB Case Management (TBCM) database of the National TB Program (2014-2015) and the database of the National Health Security Office (NHSO; 2010-2011). Results: There were 8,301 elderly patients with TB in the TBCM cohort and 11,869 in the NHSO cohort. Overall treatment success rates were 78.5% for patients in the TBCM cohort and 87.5% for patients in the NHSO cohort. High success rates for treatment were found for those aged 60-69 years: 91.1% in 2010-2011 and 85.0% in 2014-2015. High mortality was reported for patients aged >= 90 years: 34.6% in 2010-2011 and 50.0% in 2014-2015. Conclusions: Compared with the NHSO historical cohort, success rates for treatment were lower and death rates were higher in the TBCM cohort. Because NHSO enforced intensive case monitoring and follow-up while TBCM has no such mechanism, the estimates from the TBCM database may be less accurate for TB circumstances in Thailand. Frequent routine home visits may ensure more complete treatment-care information and support, and increase the treatment success rate in the elderly.