Gender difference in mortality among pulmonary tuberculosis HIV co-infected adults aged 15-49 years in Kenya

Rose J. Kosgei, Steven Callens, Peter Gichangi, Marleen Temmerman, Anne Beatrice Kihara, Gathara David, Eunice Nyaboe Omesa, Enos Masini, E. Jane Carter

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5 Citations (Scopus)

Abstract

Setting: Kenya, 2012-2015 Objective: To explore whether there is a gender difference in all-cause mortality among smear positive pulmonary tuberculosis (PTB)/ HIV co-infected patients treated for tuberculosis (TB) between 2012 and 2015 in Kenya. Design: Retrospective cohort of 9,026 smear-positive patients aged 15-49 years. All-cause mortality during TB treatment was the outcome of interest. Time to start of antiretroviral therapy (ART) initiation was considered as a proxy for CD4 cell count. Those who took long to start of ART were assumed to have high CD4 cell count. Results: Of the 9,026 observations analysed, 4,567(51%) and 4,459(49%) were women and men, respectively. Overall, out of the 9,026 patients, 8,154 (90%) had their treatment outcome as cured, the mean age in years (SD) was 33.3(7.5) and the mean body mass index (SD) was 18.2(3.4). Men were older (30% men' vs 17% women in those -40 years, p = >0.001) and had a lower BMI >18.5 (55.3% men vs 50.6% women, p = >0.001). Men tested later for HIV: 29% (1,317/4,567) of women HIV tested more than 3 months prior to TB treatment, as compared to 20% (912/4,459) men (p>0.001). Mortality was higher in men 11% (471/4,459) compared to women 9% (401/4,567, p = 0.004). There was a 17% reduction in the risk of death among women (adjusted HR 0.83; 95% CI 0.72-0.96; p = 0.013). Survival varied by age-groups, with women having significantly better survival than men, in the age-groups 40 years and over (log-rank p = 0.006). Conclusion: Women with sputum positive PTB/HIV co-infection have a significantly lower risk of allcause mortality during TB treatment compared to men. Men were older, had lower BMI and tested later for HIV than women.

Original languageEnglish
Article numbere0243977
JournalPLoS ONE
Volume15
Issue number12 December
DOIs
Publication statusPublished - Dec 2020

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