Factors Affecting to Survival Rate among New Pulmonary Tuberculosis at Hospitals in Buriram Province, 2019 – 2024

Abstract

This is an analytical retrospective cohort study aiming to investigate the factors affecting survival rates, make comparative analyses, and determine the overall survival rates among new pulmonary tuberculosis cases after diagnosis who received treatment at hospitals in Buriram province. Patients from the National Tuberculosis Information Program (NTIP) with diagnostic codes ICD-10: A15 - A16 between January 1, 2019, and December 31, 2023, from the Bureau of Registration Administration (BORA). All patients were followed up until their final status was determined as of December 31, 2024. Survival analysis was performed using the Kaplan-Meier method, with presentation of survival rates at various time points, accompanied by 95% confidence intervals. Comparisons between groups were conducted using the Log-rank test, with p-values reported. The relationships between various factors and survival time were analyzed using Cox regression, presenting Adjusted Hazard Ratios (HR) with 95% confidence intervals and p-values derived from the partial likelihood ratio test.

Among the 5,295 new pulmonary tuberculosis patients studied, the majority were male (n=3,674, 69.4%), with a mean age of 56.0 years (S.D. = 15.7 years). first sputum positivity AFB 3+ (n=1,030, 19.5%), treatment with the new patient regimen (n=5,265, 99.4%). During the follow-up period of 15,617.9 person-years, 503 patients died, resulting in a mortality rate of 3.2 per 100 person-years (95% CI: 2.95 – 3.51). Survival rates at 1, 3, and 5 years were 91.5% (95% CI: 90.67 – 92.19), 90.5% (95% CI: 89.61 – 91.23), and 89.8% (95% CI: 88.85 – 90.63), respectively. After controlling for all variables in the model, Age, Patients aged 60 years or older (adj.HR = 2.66, 95% CI; 2.19 - 3.23), alcoholism (adj.HR = 2.80, 95% CI; 2.12 - 3.70), HIV-infected (adj.HR = 3.31, 95% CI: 2.42 - 4.54) first sputum AFB smear 1+ (adj.HR =  1.15, 95% CI; 0.91 - 1.45), AFB 2+ (adj.HR = 1.23, 95% CI; 0.94 - 1.60), AFB 3+ (adj.HR =  1.53, 95% CI; 1.21 - 1.93) and chest X-ray (adj.HR = 2.15, 95% CI; 1.58 to 2.92) were significantly associated with diagnosis survival of new pulmonary tuberculosis patients (p-value<0.05).

The conclusion of this study identified several factors significantly associated with survival rates of new pulmonary tuberculosis patients after diagnosis: age, alcoholism, HIV status, first sputum, and chest X-ray. Physicians providing treatment should carefully consider these factors to determine the most appropriate therapeutic approach. Taking these factors into account during treatment planning can help improve long-term survival outcomes for new pulmonary tuberculosis patients.