MORTALITY IN PATIENTS WITH TUBERCULOSIS (TB) IN AUCKLAND, NEW ZEALAND OVER A 10 YEAR PERIOD (2009-2019)

Abstract

Intro: New Zealand has a low burden of Tuberculosis (TB) with a mortality of 0.26 per 100,000. The aim of this audit was to review the cause of mortality, classify whether the death was TB-related and identify any associated factors for patients with TB who died prior to completion of treatment for TB in Auckland. Methods: A retrospective audit of clinical notes for adult TB patients (aged >15) who died prior to commencing or during TB treatment between 2009-2019 was performed. Cause of death was classified as a TB-related death if it was found to be directly related to TB. Findings: Of the 1738 TB cases notified, 86 (4.9%) patients died prior to completion of TB treatment; 6 were excluded from further analysis due to incomplete documentation. Of the remaining 80 patients, 60% were male and the median age was 70 (range 25-97). 45% patients were of Asian ethnicity, 31% Pacific Island, 13% Maori and 8% European. 45% were smear positive at presentation, 29% had disseminated TB disease and 5% had central nervous system TB disease. 41% of patients had diabetes, 36% had renal impairment and 23% had malignancy. 30% died prior to commencing TB treatment, with the majority having TB confirmed after death. Death was felt to be directly related to TB disease in 31 (39%) patients or in 31/1738 (1.8%) of the total cohort. Discussion: TB mortality, which is potentially preventable with early detection and treatment, continues to be significant in our low TB incidence setting. More data is needed to understand the role of older age, male sex, smear positivity, and diabetes as contributing factors for increasing mortality. Conclusion: This audit highlights the need for clinicians to be vigilant and consider a diagnosis of TB to enable timely diagnosis, especially in low TB burden settings.