Effect of case detection strategies on the prognosis of tuberculosis patients in the state of São Paulo, Brazil, 2010-19: A retrospective cohort study.

IF 2.6 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Tropical Medicine & International Health Pub Date : 2024-12-26 DOI:10.1111/tmi.14074
José Mário Nunes da Silva, Fredi Alexander Diaz-Quijano
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Abstract

Background: Despite existing recommendations, there is still a scarcity of evidence on the impact of active case finding strategies versus passive case finding strategies, especially with regard to the mortality of tuberculosis patients. Therefore, our aim was to estimate the effect of case detection strategies on the prognosis of tuberculosis patients.

Methods: We conducted a retrospective cohort study of 160,384 new cases of tuberculosis patients diagnosed between 1 January 2010 and 31 August 2019 in the state of São Paulo, Brazil. We classified exposure into: passive case finding (emergency room, outpatient clinics or hospital settings) and active case finding (institutions, community or contact investigation). The primary outcome was all-cause mortality, and the secondary outcome was a composite outcome with treatment outcomes. We investigated associations using logistic regression, allowing for municipality-level random effects.

Results: Compared with outpatient passive case finding, passive case finding in the emergency room and in the hospital showed higher odds of death (adjusted odds ratio [OR] 3.69; 95% CI: 3.47-3.93 and 4.47; 95% CI: 4.22-4.74, respectively) and unfavourable treatment outcomes (1.92; 95% CI: 1.84-1.99 and 2.06; 95% CI: 1.98-2.14, respectively). By contrast, patients detected through community-based active case finding and contact investigation showed lower odds of death (0.77; 95% CI: 0.61-0.97 and 0.71; 95% CI: 0.54-0.92, respectively) and unfavourable treatment outcomes (0.85; 95% CI: 0.77-0.95 and 0.82; 95% CI: 0.74-0.91, respectively).

Conclusion: Community-based active case finding and contact investigation were associated with better prognosis than passive strategies in tuberculosis patients. Our results highlight the importance of strengthening active case finding as a fundamental part of mitigating the disease burden and controlling tuberculosis.

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2010- 2019年巴西圣保罗州病例检测策略对结核病患者预后的影响:一项回顾性队列研究
背景:尽管已有建议,但关于主动病例发现策略与被动病例发现策略的影响,特别是在结核病患者死亡率方面,仍然缺乏证据。因此,我们的目的是评估病例检测策略对结核病患者预后的影响。方法:我们对巴西圣保罗州2010年1月1日至2019年8月31日期间诊断的160,384例新发结核病患者进行了回顾性队列研究。我们将暴露情况分为:被动病例发现(急诊室、门诊诊所或医院环境)和主动病例发现(机构、社区或接触者调查)。主要结局是全因死亡率,次要结局是治疗结局的复合结局。我们使用逻辑回归调查关联,允许市级随机效应。结果:与门诊被动发现病例相比,急诊室和医院被动发现病例的死亡几率更高(调整优势比[OR] 3.69;95% CI: 3.47-3.93和4.47;95% CI分别为4.22-4.74)和不良治疗结果(1.92;95% CI: 1.84-1.99和2.06;95% CI分别为1.98-2.14)。相比之下,通过社区主动病例发现和接触者调查发现的患者死亡几率较低(0.77;95% CI: 0.61-0.97和0.71;95% CI分别为0.54-0.92)和不良治疗结果(0.85;95% CI: 0.77-0.95和0.82;95% CI分别为0.74-0.91)。结论:以社区为基础的主动病例发现和接触者调查与被动策略相比,预后更好。我们的结果强调了加强主动病例发现作为减轻疾病负担和控制结核病的基本部分的重要性。
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来源期刊
Tropical Medicine & International Health
Tropical Medicine & International Health 医学-公共卫生、环境卫生与职业卫生
CiteScore
4.80
自引率
0.00%
发文量
129
审稿时长
6 months
期刊介绍: Tropical Medicine & International Health is published on behalf of the London School of Hygiene and Tropical Medicine, Swiss Tropical and Public Health Institute, Foundation Tropical Medicine and International Health, Belgian Institute of Tropical Medicine and Bernhard-Nocht-Institute for Tropical Medicine. Tropical Medicine & International Health is the official journal of the Federation of European Societies for Tropical Medicine and International Health (FESTMIH).
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