Epidemiology, outcomes, and factors associated with mortality in pediatric tuberculosis in Thailand: A National Health Security Office Data Analysis from 2015 to 2023

Objectives Pediatric tuberculosis (TB) remains a major public health concern in low- and middle-income settings. This study described national epidemiology, trends, and factors associated with in-hospital mortality among children and adolescents with TB in Thailand. Methods A nationwide retrospective study was built from the National Health Security Office database for admissions under the Universal Coverage Scheme (2015-2023). Children aged 1 month to 18 years with TB (ICD-10-TM A15-A19) were included. Annual prevalence was calculated per 100,000 NHSO-covered population. Multivariable logistic regression identified factors associated with death. Results Among 14,080 admissions, national prevalence declined from 13.5 to 10.8 per 100,000 population, and in-hospital mortality fell from 3.5% (2015) to 2.9% (2023). Older adolescents (15-18 years) had the greatest admission burden and higher odds of in-hospital death than children Conclusion National prevalence and in-hospital mortality declined modestly, yet deaths clustered in adolescents and in children with comorbidities, central nervous system disease, and acute organ failure. Active case-finding and targeted clinical pathways for these vulnerable groups are needed to further reduce mortality.