Survival of Cuban Patients with Pulmonary Tuberculosis (2009-2010)

INTRODUCTION Tuberculosis is the second leading cause of infectious-disease death worldwide, after AIDS. Most tuberculosis patients in Cuba have pulmonary TB and recovery rates are high. When TB chemotherapy fails, the most common adverse outcome is death. OBJECTIVE Determine survival patterns in a cohort of pulmonary TB patients in Cuba. METHODS A retrospective cohort study was conducted of pulmonary TB patients who were notified and treated in Cuba in 2009 and 2010. Time elapsed between diagnosis and death was examined. Patient survival was analyzed with the Kaplan-Meier method and comparisons were made with the log-rank estimator; an adjusted Cox model was used to analyze risk of death. RESULTS The study included 1339 patients, of whom 71.7% were aged 25-64 years and 77.4% were men. Infectious pulmonary tuberculosis was the most common form (75.6%). Only a small number of patients (5.7%) presented TB/HIV coinfection. Ninety-four deaths were reported, 55% during the first 60 days of treatment. Lower survival rates were observed among men (HR 1.87, 95% CI 1.02-3.45), patients coinfected with HIV/AIDS (HR 6.25, 95% CI 3.46-11.31), and patients aged >= 48 years (HR 3.93, 95% CI 2.41-6.40). CONCLUSION The preponderance of deaths early in TB treatment course may be related to diagnostic and/or treatment delays. Older age at diagnosis, male sex and TB/HIV coinfection increase risk of death.