Higher mortality rate amongst multidrug-resistant tuberculosis patients with non-standard treatment: A long-term follow-up study in Wuhan, China

OBJECTIVES: Multidrug-resistant tuberculosis (MDR-TB) is still a severe threat to the global public health, with 40 % of patients failing treatment. However, the outcome of these patients is rarely reported. Therefore, analyzing the survival rate and risk factors among MDR-TB patients with various treatment outcomes is crucial to understanding and improving their survival. METHODS: This long-term follow-up study included 555 MDR-TB patients in Wuhan, China, with follow-up time of 3846 person-years (PY). Demographic and clinical data, along with follow-up information, were systematically collected. Survival rates were analyzed using Kaplan-Meier curves, and risk factors for mortality were identified using Cox proportional-hazards regression. RESULTS: Overall mortality was 40.36 % (224/555), with tuberculosis as the primary cause (76.3 %, 171/224) of fatalities, followed by suicide, lung cancer, and chronic obstructive pulmonary disease (COPD). Multivariable Cox regression analysis identified low education level (primary school or below: HR=2.075, 95 % CI: 1.338-3.218), advanced age (45-64 years: HR=2.871, 95 % CI: 1.332-6.195; ≧65 years: HR=4.295, 95 % CI: 1.875-9.846), and non-married status (HR=3.828, 95 % CI: 1.213-12.080) as independent risk factors for mortality. Notably, the survival rate of patients lost to follow-up was significantly higher than that of patients with untreated and treatment failure outcomes. CONCLUSION: Our results showed the high mortality rate of MDR-TB patients with non-standard treatment. However, the survival rate of patients with defaulted treatment can be greatly improved even if they do not receive complete treatment. This emphasizes the need for active treatment. However, the lower survival rate observed in treatment failure patients may be partially attributed to psychological distress and stigma, which are well-documented factors affecting treatment adherence and quality of life in tuberculosis patients. This shows that there is an urgent need to strengthen patients' understanding of the disease and adequate mental health education after diagnosis.