Causes of Death in North Carolina Tuberculosis Patients, 1993-2004

Setting: A cohort of 5,311 patients reported to the North Carolina Tuberculosis Control program from 1993-2003. Objective: To examine the leading causes of death in North Carolina tuberculosis patients and to determine risk factors for death, in particular deaths due to tuberculosis, in this population. Design: This is a retrospective cohort study using data extracted from the North Carolina Tuberculosis Control Program from 1993-2003 linked to data about time and causes of death as recorded on death certificates through the United States National Death Index. Results: A total of 1,616 patients died over the study period, representing 30.1% of our cohort, with 540 (10.5%) of these deaths occurring during tuberculosis treatment. Risk factors for death were increasing age, male sex (OR 1.14 95% CI 1.02-.139), US citizenship (OR 4.7 95% CI 2.6-8.5), known HN seropositivity (7.3 95% CI 5.8-9.4) or unknown HN status (1.53 95% CI 1.30-1.81) and unknown alcohol status (OR 1.84 95% CI 1.52-2.24). Ten percent of deaths in our cohort were due directly to tuberculosis, another 13% were due to HN and 22% were due to other pulmonary diseases. Excessive alcohol use was associated with an increased risk of death by TB (OR 1. 70, 95% CI 1.01-2.85) while male sex had a protective effect (OR 0.69 95% CI 0.49-0.98). Conclusion: The case-fatality rate in this cohort of North Carolina TB patients remains high, with many of these deaths being due either directly to tuberculosis or related diseases such as HN or pulmonary disease.