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 <5 years (adjusted odds ratio [AOR] 1.86; 95% confidence interval [CI]: 1.31-2.65). Relative to the capital, Bangkok, admissions in non-capital regions-particularly the Central region-had higher mortality (AOR 2.13; 95% CI: 1.43-3.18; P < 0.001). Independent associations with death included HIV co-infection (AOR 3.79; 95% CI: 2.93-4.90; P < 0.001), congenital heart disease (AOR 3.50; 95% CI: 1.45-8.45; P = 0.005), malnutrition (AOR 2.06; 95% CI: 1.32-3.23; P = 0.001), and TB of the nervous system (AOR 2.12; 95% CI: 1.47-3.05; P < 0.001). Organ dysfunction showed the strongest associations: septic shock (AOR 25.87; 95% CI: 18.24-36.71), acute liver failure (AOR 46.74; 95% CI: 17.99-121.38), and encephalopathy (AOR 17.43; 95% CI: 7.84-38.74) (all P < 0.001). 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.