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.