Background
Methods
Data source and study population
Outcome and predictor variables
Statistical analyses
Results
Characteristics of TB patients
Number (%) of active TB patientsa | ||
---|---|---|
N | % | |
Patient demographics
| ||
Sex- male | 992 | 53.6 |
Age group | ||
0–19 years | 143 | 7.7 |
20–34 years | 602 | 32.5 |
35–64 years | 711 | 38.4 |
65+ years | 390 | 21.1 |
Had provincial health insurance coverage | 1499 | 80.9 |
Country of birthb | ||
Canada | 317 | 17.1 |
Foreign-born, low/moderate TB incidence country | 1112 | 60.0 |
Foreign-born, high TB incidence country | 380 | 20.5 |
Immigration, years since arrival | ||
≤ 2 years | 485 | 26.2 |
3–14 years | 541 | 29.2 |
15 or more years | 338 | 18.3 |
Foreign-born, unknown year of arrival | 128 | 6.9 |
Canadian-born | 317 | 17.1 |
Homeless | 9 | 0.5 |
Patient co-morbidities
| ||
Cancer | 41 | 2.2 |
Diabetes | 132 | 7.1 |
HIV positive | 146 | 7.9 |
Renal disease | 105 | 5.7 |
Liver disease | 153 | 8.3 |
Ever substance abuse | 249 | 13.4 |
Number of co-morbiditiesc | ||
2 or more | 412 | 22.3 |
1 | 446 | 24.1 |
Ever smoker | 489 | 26.4 |
Number (%) of active TB patientsa | ||
---|---|---|
N | % | |
Mycobacteriology and disease site | ||
Pulmonary, Smear+ | 619 | 33.4 |
Pulmonary, Smear- | 625 | 33.7 |
Extra-pulmonary | 563 | 30.4 |
Clinical and radiographic features of TB disease | ||
Miliary TB | 35 | 1.9 |
Cavitary TB | 336 | 18.1 |
Any pulmonary TB-related symptomsb | 1530 | 82.6 |
Any systemic TB-related symptomsc | 1018 | 55.0 |
Drug resistance | ||
Multi- and poly-TB drug resistant | 33 | 1.8 |
Mono-TB drug resistant | 122 | 6.6 |
Pan-sensitive | 1664 | 89.8 |
Therapy supervision, ever directly-observed (DOT) | 807 | 43.5 |
Treatment duration in days, median (min-max) | 208 (183–295) | |
Treatment outcome | ||
Cured | 1518 | 82.0 |
Died | 127 | 6.9 |
Defaulted/failed | 34 | 1.8 |
Moved | 69 | 3.7 |
Characteristics of Active TB Patientsa | Foreign-born, years since arrival to Canada | Canadian-born | p-value | ||||||
---|---|---|---|---|---|---|---|---|---|
0–2 (N = 485) | 3–14 (N = 541) | 15+ (N = 338) | (N = 317) | ||||||
n
| % |
N
| % |
N
| % |
n
| % | ||
Sex, male | 281 | (57.9) | 275 | (50.8) | 172 | (51.0) | 172 | (54.2) | 0.22 |
Age group, in years | <0.01 | ||||||||
0–19 | 51 | (10.5) | 35 | (6.5) | 1 | (0.3) | 50 | (15.8) | |
20–34 | 257 | (53.0) | 233 | (43.0) | 40 | (11.8) | 37 | (11.7) | |
35–64 | 147 | (30.3) | 222 | (41.0) | 169 | (50.0) | 105 | (33.1) | |
65+ | 29 | (6.0) | 50 | (9.2) | 128 | (37.9) | 122 | (38.5) | |
Had provincial health insurance # | 213 | (43.9) | 499 | (92.2) | 328 | (97.0) | 308 | (97.2) | |
Homeless | 1 | (0.2) | 0 | (0) | 1 | (0.3) | 7 | (2.2) | <0.01 |
Ever smoker | 122 | 25.2 | 99 | 18.3 | 98 | 29.0 | 159 | 50.2 | <0.01 |
Ever substance abuse | 27 | (5.6) | 56 | (10.4) | 51 | (15.1) | 98 | (30.9) | <0.01 |
HIV | 35 | (7.2) | 51 | (9.4) | 21 | (6.2) | 28 | (8.8) | 0.38 |
Number of co-morbiditiesb | <0.01 | ||||||||
2 or more | 53 | (10.9) | 78 | (14.4) | 104 | (30.8) | 130 | (41.0) | |
1 | 93 | (19.2) | 116 | (21.4) | 102 | (30.2) | 92 | (29.0) | |
TB diagnosis | <0.01 | ||||||||
Pulmonary, Smear+ | 126 | (26.0) | 188 | (34.8) | 123 | (36.4) | 144 | (45.4) | |
Pulmonary, other | 257 | (53.0) | 124 | (22.9) | 77 | (22.8) | 108 | (34.0) | |
Extra-pulmonary | 88 | (18.1) | 219 | (40.5) | 131 | (38.8) | 55 | (17.4) | |
Any pulmonary symptomsc | 435 | (89.7) | 403 | (74.5) | 273 | (80.8) | 291 | (91.8) | <0.01 |
Any systemic symptomsd | 201 | (41.4) | 321 | (59.3) | 212 | (62.7) | 203 | (64.0) | <0.01 |
Multi- or poly-drug resistant | 13 | (2.7) | 12 | (2.2) | 2 | (0.6) | 4 | (1.3) | 0.20 |
Treatment outcome | <0.01 | ||||||||
Cured | 421 | (86.8) | 465 | (86.0) | 263 | (77.8) | 246 | (77.6) | |
Died | 3 | (0.6) | 16 | (3.0) | 41 | (12.1) | 45 | (14.2) | |
Defaulted/failed | 7 | (1.5) | 10 | (1.8) | 4 | (1.2) | 9 | (2.8) | |
Moved | 34 | (7.0) | 20 | (3.7) | 5 | (1.5) | 3 | (1.0) |
Predictors of hospitalizations and LOS
Timing of hospitalization | All hospitalizations | ||
---|---|---|---|
Initiala | Duringb | ||
Patients with any hospitalization, n (%) | 942 (50.9) | 167 (9.0) | 1001 (54.1) |
Patients with >1 hospitalization, n (%) | 114 (6.1) | 35 (1.9) | 124 (6.7) |
Total number of hospitalizations | 1006 | 206 | 1212 |
Mean length of hospital stay (LOS), in days (se) | 28.2 (39.0) | 21.6 (36.1) | 27.2 (38.6) |
Median length of hospital stay (LOS), in days (IQR) | 17.5 (9–31) | 13 (6–22) | 16.5 (8–29) |
Patients starting TB treatment in-hospital, n (%) | 731 (39.5%) | - | 731 (39.5%) |
Median # days (IQR) from admission to treat start | 4 (2–8) | - | 4 (2–8) |
Characteristics | Any initial hospitalization (yes/no) | Any hospitalization during treatment (yes/no) | ||||
---|---|---|---|---|---|---|
Number of patients (%) | Crude OR (95% CI) | Adjusted ORa (95% CI) | Number of patients (%) | Crude OR (95% CI) | Adjusted ORa (95% CI) | |
Male | 536 (54.0) | 1.30 (1.07–1.57) | - | 91 (9.2) | 1.08 (0.78–1.49) | - |
Female | 399 (47.4) | 1.00 | 72 (8.6) | 1.00 | ||
Age group | ||||||
0–19 years | 85 (59.4) | 2.04 (1.38–3.00) | 2.52 (1.63–3.92) | 15 (10.5) | 2.09 (1.10–3.97) | 2.82 (1.38–5.76) |
20–34 years | 279 (46.4) | 1.00 | 1.00 | 32 (5.3) | 1.00 | 1.00 |
35–64 years | 249 (54.7) | 1.39 (1.11–1.73) | 1.09 (0.83–1.43) | 60 (8.7) | 1.64 (1.05–2.56) | 1.11 (0.68–1.81) |
≥ 65 years | 258 (66.2) | 1.92 (1.47–2.51) | 1.13 (0.80–1.59) | 58 (14.9) | 3.11 (1.98–4.89) | 2.19 (1.25–3.85) |
Had provincial health insurance # | ||||||
Yes | 804 (53.6) | 1.75 (1.37–2.24) | - | 149 (9.9) | 2.05 (1.24–3.40) | - |
No | 138 (39.1) | 1.00 | 18 (5.1) | 1.00 | ||
Country of birth | - | - | ||||
Canada | 196 (61.8) | 2.02 (1.48–2.75) | 51 (16.1) | 2.61 (1.59–4.30) | ||
Foreign, low-moderate TB incidence | 551 (49.6) | 1.16 (0.92–1.47) | 85 (7.6) | 1.13 (0.72–1.78) | ||
Foreign, high TB incidence country | 174 (45.8) | 1.00 | 26 (6.8) | 1.00 | ||
Immigration, years since arrival | ||||||
Foreign-born, unknown arrival date | 53 (41.4) | 0.41 (0.27–0.63) | - | 13 (10.2) | 0.59 (0.31–1.13) | - |
15 or more years | 204 (60.4) | 0.90 (0.65–1.25) | 37 (11.0) | 0.64 (0.41–1.01) | ||
3–14 years | 269 (49.7) | 0.58 (0.43–0.77) | 39 (7.2) | 0.41 (0.26–0.63) | ||
0–2 years | 199 (41.0) | 0.41 (0.30–0.54) | 22 (4.5) | 0.25 (0.15–0.42) | ||
Canadian-born | 196 (61.8) | 1.00 | 51 (16.1) | 1.00 | ||
Homeless | - | - | ||||
Yes | 8 (88.9) | 7.46 (0.93–59.66) | 2 (22.2) | 2.91 (0.60–14.11) | ||
No | 934 (50.7) | 1.00 | 165 (9.0) | 1.00 | ||
Cancer | - | |||||
Yes | 30 (73.2) | 2.23 (1.09–4.53) | 13 (31.7) | 5.00 (2.54–9.84) | 3.43 (1.63–7.23) | |
No | 912 (50.4) | 1.00 | 154 (8.5) | 1.00 | 1.00 | |
Diabetes | - | - | ||||
Yes | 98 (74.2) | 2.83 (1.88–4.26) | 21 (15.9) | 2.04 (1.24–3.35) | ||
No | 844 (49.1) | 1.00 | 146 (8.5) | 1.00 | ||
HIV | ||||||
Positive | 111 (76.0) | 3.24 (2.17–4.85) | 1.46 (0.90–2.36) | 36 (24.7) | 3.84 (2.60–5.97) | 3.31 (1.96–5.60) |
Negative or unknown | 831 (48.7) | 1.00 | 1.00 | 131 (7.7) | 1.00 | 1.00 |
Renal disease | - | |||||
Yes | 83 (79.1) | 3.92 (2.38–6.47) | 1.99 (1.10–3.59) | 22 (21.0) | 2.93 (1.78–4.83) | |
No | 859 (49.2) | 1.00 | 1.00 | 145 (8.3) | 1.00 | |
Liver disease | - | |||||
Yes | 105 (68.6) | 2.02 (1.40–2.92) | - | 25 (16.3) | 2.14 (1.35–3.40) | |
No | 837 (49.3) | 1.00 | 142 (8.4) | 1.00 | ||
Ever substance abuse | - | |||||
Yes | 176 (70.7) | 2.69 (1.99–3.63) | - | 32 (12.9) | 1.60 (1.06–2.42) | |
No | 766 (47.8) | 1.00 | 135 (8.4) | 1.00 | ||
Number of co-morbidities | ||||||
2 or more | 316 (77.3) | 5.31 (4.04–6.98) | 3.56 (2.50–5.07) | 76 (18.6) | 5.44 (3.64–8.14) | 2.90 (1.69–4.96) |
1 | 242 (53.9) | 1.84 (1.46–2.32) | 1.43 (1.08–1.89) | 51 (11.4) | 3.06 (1.99–4.70) | 2.17 (1.31–3.60) |
0 | 384 (38.6) | 1.00 | 1.00 | 40 (4.0) | 1.00 | 1.00 |
Ever smoker | - | |||||
Yes | 306 (62.6) | 1.92 (1.54–2.39) | - | 61 (12.5) | 1.69 (1.21–2.36) | |
No | 636 (46.7) | 1.00 | 106 (7.8) | 1.00 | ||
TB diagnosis | - | |||||
Pulmonary, Smear+ | 447 (72.2) | 3.87 (3.02–4.96) | 1.48 (1.04–2.09) | 70 (11.3) | 1.43 (0.97–2.12) | |
Pulmonary, Smear- | 257 (41.2) | 1.05 (0.83–1.32) | 0.65 (0.46–0.90) | 47 (7.5) | 0.91 (0.60–1.40) | |
Extra-pulmonary | 228 (40.5) | 1.00 | 1.00 | 46 (8.2) | 1.00 | |
Cavitary TB | - | |||||
Yes | 230 (68.5) | 2.49 (1.92–3.23) | 1.75 (1.28–2.40) | 25 (7.4) | 0.76 (0.48–1.19) | |
No | 712 (47.0) | 1.00 | 1.00 | 142 (9.4) | 1.00 | |
Miliary TB | ||||||
Yes | 29 (82.9) | 5.33 (2.05–13.87) | 3.53 (1.26–9.88) | 8 (22.9) | 3.09 (1.38–6.92) | 2.09 (0.88–4.96) |
No | 913 (50.3) | 1.00 | 1.00 | 159 (8.8) | 1.00 | 1.00 |
Any pulmonary TB-related symptoms | ||||||
Yes | 853 (55.8) | 3.45 (2.63–4.53) | 2.12 (1.44–3.11) | 149 (9.7) | 1.77 (1.07–2.93) | - |
No | 89 (27.6) | 1.00 | 1.00 | 18 (5.6) | 1.00 | |
Any systemic TB-related symptoms | ||||||
Yes | 697 (68.5) | 5.18 (4.22–6.36) | 3.54 (2.82–4.46) | 123 (12.1) | 2.44 (1.70–3.50) | 1.72 (1.16–2.57) |
No | 245 (28.4) | 1.00 | 1.00 | 44 (5.3) | 1.00 | 1.00 |
Multidrug or poly-drug resistance | ||||||
Yes | 26 (78.8) | 3.95 (1.61–9.67) | 6.98 (2.65–18.30) | 8 (24.2) | 3.48 (1.54–7.89) | 5.55 (2.18–14.14) |
No | 914 (51.2) | 1.00 | 1.00 | 157 (8.8) | 1.00 | 1.00 |
Initial hospitalizations (n = 1006) | Hospitalizations during treatment (n = 206) | |||
---|---|---|---|---|
Characteristics | Crude HR (95% CI) | Adjusted HRa,b (95% CI) | Crude HR (95% CI) | Adjusted HRa (95% CI) |
Sex | ||||
Male | 1.01 (0.89–1.14) | - | 1.29 (0.78–2.11) | - |
Female | 1.00 | 1.00 | ||
Age in yearsc | 0.99 (0.98–1.00) | |||
log(LOS) ≤ 2.5 | 1.02 (1.02–1.03) | 1.02 (1.02–1.03) | - | - |
log(LOS) > 2.5 | 0.96 (0.96–0.96) | 0.96 (0.96–0.96) | - | - |
Had provincial health insurance # | ||||
Yes | 0.96 (0.81–1.14) | - | 1.15 (0.63–2.10) | - |
No | 1.00 | 1.00 | ||
Country of birth | ||||
Canada | 0.68 (0.55–0.83) | - | 0.80 (0.47–1.37) | - |
Foreign, low-moderate incidence | 0.88 (0.74–1.04) | 0.57 (0.33–0.98) | ||
Foreign, high incidence country | 1.00 | 1.00 | ||
Immigration, years since arrival | ||||
Foreign-born, unknown arrival date | 1.47 (1.13–1.91) | - | 0.57 (0.28–1.15) | - |
15 or more years | 1.11 (0.92–1.35) | 0.70 (0.34–1.44) | ||
3–14 years | 1.50 (1.26–1.79) | 0.85 (0.50–1.42) | ||
0–2 years | 1.42 (1.17–1.71) | 1.15 (0.58–2.28) | ||
Canadian-born | 1.00 | 1.00 | ||
Homeless | - | - | ||
Yes | 0.89 (0.56–1.40) | 0.26 (0.11–0.63) | ||
No | 1.00 | 1.00 | ||
Cancer | - | |||
Yes | 0.82 (0.55–1.23) | 1.42 (0.89–2.26) | - | |
No | 1.00 | 1.00 | ||
Diabetes | - | |||
Yes | 0.92 (0.76–1.11) | 1.05 (0.63–1.75) | - | |
No | 1.00 | 1.00 | ||
HIV | ||||
Positive | 0.83 (0.70–0.99) | 0.77 (0.66–0.90) | 0.93 (0.59–1.47) | 0.61 (0.40–0.91) |
Negative or unknown | 1.00 | 1.00 | 1.00 | 1.00 |
Renal disease | ||||
Yes | 0.55 (0.43–0.70) | 0.59 (0.46–0.75) | 0.45 (0.21–0.95) | 0.58 (0.31–1.10) |
No | 1.00 | 1.00 | 1.00 | 1.00 |
Liver disease | ||||
Yes | 0.79 (0.66–0.94) | - | 1.62 (0.99–2.66) | - |
No | 1.00 | 1.00 | ||
Ever substance abuse | ||||
Yes | 0.91 (0.79–1.05) | - | 0.88 (0.58–1.33) | - |
No | 1.00 | 1.00 | ||
Number of co-morbidities | ||||
2 or more | 0.65 (0.56–0.75) | - | 0.74 (0.44–1.25) | - |
1 | 0.85 (0.73–1.00) | 0.69 (0.36–1.31) | ||
0 | 1.00 | 1.00 | ||
Ever smoker | ||||
Yes | 0.84 (0.74–0.96) | - | 0.91 (0.59–1.40) | - |
No | 1.00 | 1.00 | ||
TB diagnosis | ||||
Pulmonary, Smear+ | 0.61 (0.51–0.72) | 0.64 (0.54–0.77) | 1.51 (0.84–2.69) | 1.26 (0.78–1.99) |
Pulmonary, Smear- | 089 (0.73–1.09) | 1.02 (0.84–1.26) | 1.50 (0.80–2.83) | 1.81(1.07–3.04) |
Extra-pulmonary | 1.00 | 1.00 | 1.00 | 1.00 |
Cavitary TB | ||||
Yes | 0.92 (0.90–1.05) | - | 1.91 (1.13–3.25) | - |
No | 1.00 | 1.00 | ||
Miliary TB | ||||
Yes | 0.83 (0.63–1.10) | - | 1.13 (0.70–1.83) | - |
No | 1.00 | 1.00 | ||
Any pulmonary TB-related symptoms | ||||
Yes | 0.65 (0.50–0.85) | 0.70 (0.55–0.90) | 0.61 (0.42–0.90) | 0.46 (0.27–0.80) |
No | 1.00 | 1.00 | 1.00 | 1.00 |
Any systemic TB-related symptoms | ||||
Yes | 0.80 (0.69–0.93) | - | 1.16 (0.60–2.26) | - |
No | 1.00 | 1.00 | ||
Multidrug or poly-drug resistance | ||||
Yes | 0.65 (0.50–0.85) | 0.44 (0.32–0.60) | 0.62 (0.28–1.39) | 0.28 (0.12–0.66) |
No | 1.00 | 1.00 | 1.00 | 1.00 |
Teaching hospital | ||||
Yes | 0.86 (0.75–0.99) | 0.81 (0.71–0.92) | 0.99 (0.62–1.59) | - |
No | 1.00 | 1.00 | 1.00 |