Elevated mortality following diagnosis with a treatable disease: tuberculosis.

Abstract

OBJECTIVE: To determine whether previous diagnosis with tuberculosis (TB) increases the risk of mortality. DESIGN: A retrospective survey of 439 TB patients in the city of Liverpool, population 439500, over an 8-year period. OUTCOMES: Mortality compared with the general population; cause of death as identified from death certificates. RESULTS: A total of 104 (23.7%) TB cases had died within the follow-up period. For 45-54 year olds, the standardised mortality ratio (SMR) was 1101, an 11-fold higher mortality than expected from the Liverpool population. The SMR then declined with age, but remained higher in males than in females. Death certificates showed that 34 (30.8%) died from TB and 26 (21%) from bronchopneumonia. Malignancy was the cause of death in 24 cases (28%), including 16 with lung tumours, all in patients aged under 75 years. This gave a 30-fold greater mortality from lung cancer compared with the general population aged under 75. CONCLUSIONS: TB increases the risk of mortality compared with the general population, with unexpectedly high mortality from lung cancer in cases aged under 75. Older patients die from TB itself or other chest diseases. Common risk factors for the Liverpool population probably contribute to elevated mortality from all chest-related diseases, including TB.