Relationship between multimorbidity and the outcome of the treatment for pulmonary tuberculosis

Soares, Luciana Nunes; Spagnolo, Lílian Moura de Lima; Tomberg, Jéssica Oliveira; Zanatti, Christian Loret de Mola; Cardozo-Gonzales, Roxana Isabel

doi:10.1590/1983-1447.2020.20190373

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Original Article • Rev. Gaúcha Enferm. 41 • 2020 • https://doi.org/10.1590/1983-1447.2020.20190373 copy

Relationship between multimorbidity and the outcome of the treatment for pulmonary tuberculosis

Relación entre la multimorbilidad y el resultado del tratamiento de la tuberculosis pulmonar

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the influence of multimorbidity on the treatment outcome of new cases of pulmonary tuberculosis.

Method:

A population-based analytical study, using secondary data, collected from the database of the Notification Disease Information System, of new cases of pulmonary tuberculosis in the state of Rio Grande do Sul between 2013 and 2016. The relationship between multimorbidity and the outcome was analyzed with Multinomial Logistic Regression.

Results:

Multimorbidity was present in 37.0% of the cases. Of these, the Relative Risk (RR) was 1.7 for treatment abandonment and 2.9 for death. HIV had an RR of 2.1 for dropout and of 3.9 for death. The higher the number of comorbidities, the higher the RR for unfavorable outcomes.

Conclusion:

Multimorbidity influences on unfavorable outcomes of the treatment for tuberculosis.

Keywords:
Tuberculosis; Multimorbidity; Comorbidity; Treatment outcome; Epidemiological monitoring

Variable (N)	n	%
Gender (14,322)
Female	4,726	33.0
Male	9,596	67.0
Age in years old (14,159)
0 to 17	617	4.4
18 to 30	3,733	26.3
31 to 40	2,951	20.7
41 to 50	2,520	17.7
51 to 59	2,037	14.4
60 and older	2,301	16.5
Skin color (13,885)
White	9,894	71.3
Non-white	3,991	28.7
Schooling (11,099)
Illiterate	514	4.6
Incomplete Elementary	6,364	57.4
Complete Elementary	2,365	21.3
Complete Secondary	1,498	13.5
Higher Education Degree	358	3.2
Government Benefit (7,244)
No	6,795	93.8
Yes	449	6.2
Area of residence (13,885)
Rural	630	4.5
Urban	13,255	95.5
Institutionalized population (6,271)
No	5,422	86.5
Yes	825	13.5
Street population (8,436)
No	8,082	95.8
Yes	354	4.2

Variables (n)	n	%
Presence of multimorbidity (12,396)
No	7,809	63.0
Yes	4,587	37.0
Number of morbidities (12,396)
Only tuberculosis	7,809	63.0
Tuberculosis+1	3,749	30.3
Tuberculosis +2	759	6.1
Tuberculosis and 3 others or more	79	0.6
HIV (13,049)
No	10,741	82.3
Yes	2,308	17.7
Mental Illness (13,618)
No	13,130	96.4
Yes	488	3.6
Diabetes (13,426)
No	12,373	92.2
Yes	1,053	7.8
Illicit drugs (8,205)
No	6,926	84.4
Yes	1,279	15.6
Smoking (8,168)
No	5,621	68.8
Yes	2,547	31.2
Alcoholism (13,579)
No	11,364	83.7
Yes	2,215	16.3
Directly Observed Treatment (12,126)
No	9,053	74.7
Yes	3,073	25.3
Treatment outcome (14,323)
Cure	10,208	71.3
Abandonment	2,379	16.6
Death	1,384	9.7
Multi-drug resistance	352	2.4

Characteristics	Abandonment			Death			Multi-drug resistance
	RR	95% CI	p	RR	95% CI	p	RR	95% CI	p
Multimorbidity
Yes	1.7	1.6-1.9	<0.001	2.9	2.5-3.3	<0.001	2.5	1.9-3.1	<0.001
No. of morbidities
Tuberculosis+1	1.6	1.4-1.8	<0.001	2.7	2.3-3.0	<0.001	2.4	1.8-2.9	<0.001
Tuberculosis +2	2.5	2.1-2.9	<0.001	3.7	3.0-4.7	<0.001	3.3	2.3-4.9	<0.001
Tuberculosis and 3 others or more	2.1	1.2-3.9	0.010	7.4	4.4-12.4	<0.001	3.0	2.9-5.0	0.980
Associated diseases*
HIV	2.1	1.9-2.4	<0.001	3.9	3.3-4.6	<0.001	3.1	2.3-4.1	<0.001
Mental Illness	0.8	0.6-1.1	0.156	1.5	1.1-2.1	0.018	0.8	0.3-1.7	0.625
Diabetes Mellitus	0.5	0.4-0.7	<0.001	1.2	0.9-1.5	0.177	1.5	0.9-2.2	0.069
Smoking	0.8	0.7-1.0	0.067	1.0	0.8-1.3	0.904	1.1	0.8-1.5	0.613
Alcoholism	1.3	1.1-1.6	0.003	1.5	1.2-1.9	0.001	1.3	0.9-2.0	0.128
Illicit drugs	3.1	2.6-3.7	<0.001	0.9	0.7-1.2	0.690	1.1	0.7-1.7	0.670

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
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[1] Corresponding author:
Jéssica Oliveira Tomberg E-mail: jessicatomberg@hotmail.com