马来西亚结核病随访损失（LTFU）的特征和预后因素——2014年至2018年的5年回顾性队列研究

IF 4 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-07-24 DOI:10.1016/j.jiph.2025.102913

Ahmad Yusri Abd Rani , Nurhuda Ismail , Yuslina Zakaria , Mohamad Rodi Isa

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引用次数: 0

摘要

结核病（TB）失访（LTFU）破坏了治疗，影响了患者的预后，并加剧了公共卫生挑战。本研究评估了2014年至2018年马来西亚成人结核病LTFU的患病率、到LTFU的时间和预后因素。方法使用MyTB数据库的国家数据进行回顾性队列分析，包括97,542例结核病患者。Kaplan-Meier分析确定了到达LTFU的时间，Cox比例风险分析确定了重要的预后因素。结果结核病LTFU患病率由2014年的7.09 %下降至2018年的5.71 %。强化期至LTFU的平均时间为54.8 d，持续期为162.5 d。LTFU的重要危险因素包括年龄<； 65岁、男性、城市居住、吸烟、糖尿病和在政府机构开始治疗。值得注意的是，在持续期没有直接观察治疗（DOT）明显增加了LTFU的风险(调整后HR 33.18；95 % ci: 31.02-35.48)。结论：尽管结核病LTFU患病率呈下降趋势，但年龄更小、居住在城市以及继续治疗期间缺乏DOT仍然是主要挑战。加强dots的实施和针对高危人群的有针对性的干预措施，对于减少结核病长期结核杆菌感染和提高治疗依从性至关重要。

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Characteristics and prognostic factors of TB loss to follow up (LTFU) in Malaysia – A 5-year retrospective cohort from 2014 to 2018

Background

Tuberculosis (TB) loss to follow-up (LTFU) disrupts treatment, compromises patient outcomes, and exacerbates public health challenges. This study evaluates the prevalence, time to LTFU, and prognostic factors of TB LTFU among adults in Malaysia between 2014 and 2018.

Methods

A retrospective cohort analysis was conducted using national data from the MyTB database, comprising 97,542 TB patients. Kaplan-Meier analysis determined the time to LTFU, while Cox proportional hazards analysis identified significant prognostic factors.

Results

The prevalence of TB LTFU decreased from 7.09 % in 2014 to 5.71 % in 2018. The mean time to LTFU was 54.8 days during intensive phase and 162.5 during continuation phase. Significant risk factors for LTFU included age < 65 years, male gender, urban residence, smoking, diabetes, and initiation of treatment at government facilities. Notably, the absence of Directly Observed Therapy (DOT) during the continuation phase markedly increased LTFU risk (adjusted HR 33.18; 95 % CI: 31.02–35.48).

Conclusion

Despite a declining trend in TB LTFU prevalence, younger age, urban residence, and lack of DOT during continuation remain key challenges. Strengthening DOT implementation and targeted interventions for at-risk groups are crucial for reducing TB LTFU and improving treatment adherence.

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.