Predictive factors for hospital self-discharge in tuberculosis admissions in the state of Rio de Janeiro, from 2011-2018: a retrospective cohort study.

Abstract

Objective: To assess factors associated with hospital self-discharge of patients with tuberculosis in the state of Rio de Janeiro, Brazil, 2011-2018.

Methods: This was a retrospective cohort study in a referral hospital. Clinical and epidemiological characteristics were compared according to hospitalization outcome (self-discharge, formal discharge, or death). Hazard ratios (HR) with 95% confidence intervals (95%CI) for the association of self-discharge with explanatory variables were estimated using Cox regression.

Results: Of the 1429 hospitalizations, 10.4% ended in self-discharge. Female sex (HR = 1.47; 95%CI 1.03;2.11), age ≤ 42 years (HR = 2.01; 95%CI 1.38; 2.93), substance use (HR = 1.62; 95%CI 1.12; 2.34), hospitalization after treatment dropout (HR = 2.04; 95%CI 1.37; 3.04), and homelessness (HR = 2.5; 95%CI 1.69; 3.69) were associated with self-discharge.

Conclusion: Patients with social vulnerability require more careful monitoring during hospitalization.

Main results: Homeless people, illicit drug use, female sex and history of dropout from previous treatment showed association with hospital self-discharge in patients with tuberculosis admitted to a reference hospital in the state of Rio de Janeiro.

Implications for services: Need for more comprehensive support for vulnerable patients, in addition to promoting treatment adherence and training health professionals to deal with the complex psychosocial issues related to tuberculosis.

Perspectives: It is crucial to develop public policies that consider social factors in tuberculosis management, as well as promoting cooperation and multisectoral approaches to address both tuberculosis and underlying social issues.