Mortality of tuberculosis patients during treatment in Israel, 2000-2010

SETTING: Tuberculosis (TB) epidemiology in Israel is similar to that reported from other industrialised countries where most patients are foreign-born. OBJECTIVES: To assess TB case fatality rate (CFR) and mortality trends during treatment and to identify risk factors associated with mortality. DESIGN: Retrospective cohort study of all TB patients in Israel diagnosed between 2000 and 2010. Cause of death was classified by TB-specific and non-TB-specific causes. RESULTS: During the study period, 451 TB patients died during treatment, representing a CFR of 9.9%. Of these, 72.5% died due to TB-related causes, giving a TB-related CFR of 7.2%. Both the overall and TB-related CFR decreased over the study period. Risk factors for death included male sex, older age, human immunodeficiency virus coinfection, culture positivity and multidrug-resistant TB (MDR-TB). Patients aged >= 65 years comprised 70% of the TB-related deaths, and more than half of these (54.9%) were born in the former Soviet Union, Europe (excluding the former Soviet Union) or the USA. CONCLUSION: Both the overall and TB-related CFR decreased over the study period. Physicians who treat older male TB patients with MDR-TB or HIV should increase the index of suspicion to include the possibility of a higher risk of mortality.