Prevalence and risk factors associated with tuberculosis mortality in Brunei Darussalam

Objective:To determine the prevalence and risk factors associated with tuberculosis mortality in Brunei Darussalam and to explore its underlying causes.Methods:A retrospective cohort study was conducted where data on socio-demographics,clinical characteristics and treatment outcomes of all tuberculosis patients registered at the National tuberculosis Coordinating Centre between 2013 and 2017 were collected.Overall tuberculosis mortality and the proportion of tuberculosis-related deaths were calculated.Logistic regression analysis was used to determine the risk factors of tuberculosis mortality when compared to those who are cured and/or completed tuberculosis treatment.Results:Of 1107 tuberculosis cases,99 died,giving an overall tuberculosis mortality rate of 8.9%(95%CI 7.4%-10.8%).Significant risk factors associated with tuberculosis mortality were age≥40 years(adjusted OR for 40-59 years was 3.89;95%CI 1.13-1.69;adjusted OR for≥60 years was 22.3;95%CI 7.27-91.9,using 20-39 years as reference),female sex(adjusted OR 1.74;95%CI 1.09-2.79),having renal disease(adjusted OR 25.7;95%CI 2.82-191.50)and having any cancers(adjusted OR 3.61;95%CI 1.26-10.00).The majority(75.8%)of the recorded deaths were not related to tuberculosis.Conclusions:Tuberculosis patients who were older than 40 years,female,and having renal disease and any cancer will need close monitoring in their management program to prevent tuberculosis mortality.Clinicians should also focus on other non-tuberculosis aspects of the patient’s medical history.