Readmission and survival of hospitalized pulmonary tuberculosis patients: a nationwide record-based cohort analysis in Thailand (2017-2022).

BACKGROUND

Assessing the readmitted diseases and survivors in patients hospitalized with pulmonary tuberculosis (TB) is crucial for healthcare strategies tailored to TB survivors. This study aims to compare readmissions and survival of hospitalized pulmonary TB patients with those of their matched controls in Thailand.

METHODS

We retrieved inpatient drug-sensitive pulmonary TB cases from the Thai Health Information Portal database (2017-2022), which included all hospitalized admissions in Thai hospitals. Non-TB controls were selected using 1∶1 propensity score matching by admission date, location, sex, age, and comorbidities. Time to readmission and to death event were the outcome variables. Cox regression with a robust variance sandwich estimator was used and then the E-value was computed. E-values indicate the strength of possible unexplained confounders.

RESULTS

From the propensity score matching, a total of 59,027 patients newly admitted for TB could be matched with 59,027 non-TB inpatient controls. Hazard ratios (HR) with 95% confidence intervals (CI) and E-values for causes of readmission among TB patients were 5.4 (2.1-14.3) and 10.2 for pericarditis, 5.4 (4.1-7.2) and 10.2 for pneumothorax, 3.8 (2.9-4.9) and 7.1 for bronchiectasis, 3.1 (2.4-4.2) and 5.6 for hyperfunction of the pituitary gland, and 2.4 (2.1-2.8) and 4.2 for inflammatory liver diseases. The TB cohort also had a higher risk of death [HR = 1.5 (95% CI: 1.4-1.6) and E-value = 2.3].

CONCLUSIONS

Hospitalized TB patients in Thailand are at higher risk than their non-TB controls in getting readmissions for thoracic problems and death. These problems call for improvement of TB care.