Posters
Presentation Type
Poster
Discipline Track
Community/Public Health
Abstract Type
Research/Clinical
Abstract
Background: After two decades of 2% annual declines in the global incidence of TB, there was a 3.6% increase between 2020 and 2021. The World Health Organization’s (WHO) ‘End TB Strategy’ is aimed at reducing TB incidence by 80% and TB deaths by 90% by 2030, compared with 2015, but its goals will not be reached at the current pace. Reacceleration of TB elimination efforts must take into consideration the changing epidemiology of TB, including an aging global population. The older adult population, aged 65 and older, is growing faster than all other age groups, and in the United States, they will outnumber children under the age of 18 for the first time by 2034. Older adults have the highest prevalence of latent TB and are prone to immune-suppressive conditions that predispose them to reactivation or new TB infection. In this study, we aimed to examine sociodemographics and clinical findings unique to older patients, when compared to younger adults, with pulmonary TB (PTB) and identify risk factors that predict adverse PTB outcomes in this age group.
Methods: Pulmonary TB surveillance data from Texas, 2008 – 2020 (n=10,656), was evaluated for patient characteristics, outcomes, and trends in older (OA, ≥65 y.) vs. young (YA, 18 to 39 y.) or middle-aged (MAA, 40 to 64 y.) adults. Multivariable logistic regression models were used to identify risk factors for treatment noncompletion and all-cause death.
Results: The OA group grew from 15% in 2008 to 24% in 2020 with the proportion of OA patients born in a country other than the U.S. or Mexico, also increasing during the surveillance period, trend P < .001. Long-term care facility residence, diabetes, and dead at diagnosis increased with age (P for trend < .001 for each) while cavities on chest x-ray and performing TB infection tests, tuberculin skin test (TST) or interferon-gamma release assays (IGRAs), decreased with age (P for trend < .001 for each). Older age was not associated with failure to complete TB treatment. However, birth in a country other than the U.S. or Mexico (aOR 2.27, 95% CI 1.27, 4.08) and homeless (aOR 4.33, 95% CI 1.63, 11.53) were associated with treatment noncompletion in the OA. The odds of death during TB treatment doubled for OA patients with an MTB positive culture (aOR 2.31, 95% CI 1.55, 3.44), while birth in Mexico (aOR 0.74, 95% CI 0.56, 0.99) or other country other than the U.S. or Mexico (aOR 0.48, 95% CI 0.33, 0.68) was protective against death.
Conclusion: In Texas, there has been an increase in the proportion of older adults with TB over the past decade and this age group is at higher risk of all-cause mortality. We recommend including older adults as a priority group in latent TB treatment guidelines to prevent the development of TB in this highly-vulnerable age group.
Academic/Professional Position
Graduate Student
Recommended Citation
Medrano, Belinda; Gemeinhardt, Gretchen L.; Lee, Miryoung; Morris, Sandra; Yamba, Lana; and Restrepo, Blanca I., "Pulmonary Tuberculosis in Older Adults, Texas, 2008 - 2020: Trends and adverse outcomes" (2024). Research Symposium. 110.
https://scholarworks.utrgv.edu/somrs/2023/posters/110
Included in
Pulmonary Tuberculosis in Older Adults, Texas, 2008 - 2020: Trends and adverse outcomes
Background: After two decades of 2% annual declines in the global incidence of TB, there was a 3.6% increase between 2020 and 2021. The World Health Organization’s (WHO) ‘End TB Strategy’ is aimed at reducing TB incidence by 80% and TB deaths by 90% by 2030, compared with 2015, but its goals will not be reached at the current pace. Reacceleration of TB elimination efforts must take into consideration the changing epidemiology of TB, including an aging global population. The older adult population, aged 65 and older, is growing faster than all other age groups, and in the United States, they will outnumber children under the age of 18 for the first time by 2034. Older adults have the highest prevalence of latent TB and are prone to immune-suppressive conditions that predispose them to reactivation or new TB infection. In this study, we aimed to examine sociodemographics and clinical findings unique to older patients, when compared to younger adults, with pulmonary TB (PTB) and identify risk factors that predict adverse PTB outcomes in this age group.
Methods: Pulmonary TB surveillance data from Texas, 2008 – 2020 (n=10,656), was evaluated for patient characteristics, outcomes, and trends in older (OA, ≥65 y.) vs. young (YA, 18 to 39 y.) or middle-aged (MAA, 40 to 64 y.) adults. Multivariable logistic regression models were used to identify risk factors for treatment noncompletion and all-cause death.
Results: The OA group grew from 15% in 2008 to 24% in 2020 with the proportion of OA patients born in a country other than the U.S. or Mexico, also increasing during the surveillance period, trend P < .001. Long-term care facility residence, diabetes, and dead at diagnosis increased with age (P for trend < .001 for each) while cavities on chest x-ray and performing TB infection tests, tuberculin skin test (TST) or interferon-gamma release assays (IGRAs), decreased with age (P for trend < .001 for each). Older age was not associated with failure to complete TB treatment. However, birth in a country other than the U.S. or Mexico (aOR 2.27, 95% CI 1.27, 4.08) and homeless (aOR 4.33, 95% CI 1.63, 11.53) were associated with treatment noncompletion in the OA. The odds of death during TB treatment doubled for OA patients with an MTB positive culture (aOR 2.31, 95% CI 1.55, 3.44), while birth in Mexico (aOR 0.74, 95% CI 0.56, 0.99) or other country other than the U.S. or Mexico (aOR 0.48, 95% CI 0.33, 0.68) was protective against death.
Conclusion: In Texas, there has been an increase in the proportion of older adults with TB over the past decade and this age group is at higher risk of all-cause mortality. We recommend including older adults as a priority group in latent TB treatment guidelines to prevent the development of TB in this highly-vulnerable age group.