Time of highest tuberculosis death risk and associated factors: an observation of 12 years in Northern Thailand

Saiyud Moolphate^1,2, Myo Nyein Aung^1,3, Oranuch Nampaisan¹, Supalert Nedsuwan⁴, Pacharee Kantipong⁵, Narin Suriyon⁶, Chamnarn Hansudewechakul⁶, Hideki Yanai⁷, Norio Yamada², Nobukatsu Ishikawa^2
1TB/HIV Research Foundation, Chiang Rai, Thailand; ²Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association (RIT-JATA), Tokyo, Japan; ³Department of Pharmacology, University of Medicine, Mandalay, Myanmar; ⁴Department of Preventive and Social Medicine, Chiang Rai Regional Hospital, Chiang Rai, Thailand; ⁵Department of Health Service System Development, Chiang Rai Regional Hospital, Chiang Rai, Thailand; ⁶Provincial Health Office, Chiang Rai, Thailand; ⁷Department of Clinical Laboratory, Fukujuji Hospital, Tokyo, Japan

Purpose: Northern Thailand is a tuberculosis (TB) endemic area with a high TB death rate. We aimed to establish the time of highest death risk during TB treatment, and to identify the risk factors taking place during that period of high risk.
Patients and methods: We explored the TB surveillance data of the Chiang Rai province, Northern Thailand, retrospectively for 12 years. A total of 19,174 TB patients (including 5,009 deaths) were investigated from 1997 to 2008, and the proportion of deaths in each month of TB treatment was compared. Furthermore, multiple logistic regression analysis was performed to identify the characteristics of patients who died in the first month of TB treatment. A total of 5,626 TB patients from 2005 to 2008 were included in this regression analysis.
Result: The numbers of deaths in the first month of TB treatment were 38%, 39%, and 46% in the years 1997–2000, 2001–2004, and 2005–2008, respectively. The first month of TB treatment is the time of the maximum number of deaths. Moreover, advancing age, HIV infection, and being a Thai citizen were significant factors contributing to these earlier deaths in the course of TB treatment.
Conclusion: Our findings have pointed to the specific time period and patients at higher risk for TB death. These findings would be useful for prioritizing interventions in order to diminish TB-related deaths globally. Studies based on these findings are necessary for the introduction of newer intervention strategies.

Keywords: tuberculosis, TB death, Thailand, time of death