Chest
Volume 100, Issue 3, September 1991, Pages 678-681
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Clinical Investigations
Tuberculosis Diagnosed at Death in the United States

https://doi.org/10.1378/chest.100.3.678Get rights and content

From 1985 through 1988, 5.1 percent of TB cases reported in the United States were diagnosed at death. Differences in the proportions diagnosed at death by race/ethnicity, sex, and place of birth (United States vs foreign-born) were relatively small. The proportion of cases diagnosed at death increased with age, from 0.7 percent in patients less than 5 years old to 18.6 percent among patients 85 years and older. Only 26.0 percent of cases diagnosed alive were among those 65 years and older, but 60.3 percent of those diagnosed at death were in this age group. Eighteen percent of cases with miliary, meningeal and peritoneal TB were diagnosed at death, compared with 4.8 percent among those with pulmonary TB. These data indicate that TB too often remains unrecognized and that, to prevent continuing deaths from this curable disease, a high index of suspicion of TB remains important, particularly among the elderly and among persons with extrapulmonary sites of disease.

(Chest 1991; 100:678-811)

Section snippets

MATERIALS AND METHODS

Since 1985, all states have submitted individual reports on each TB case to the CDC. The standard definition used by state and city health departments for reporting the vital status (alive or dead) to the CDC is written in the guide for completing case reports as follows: “Patients whose tuberculosis was suspected and who were started on at least two antituberculosis drugs prior to the day of death are classified as alive at the time of diagnosis even though the case is not verified and counted

RESULTS

Of the 86,292 cases analyzed, 81,919 (94.9 percent) were diagnosed while patients were alive, and 4,373 cases (5.1 percent) were diagnosed at death (Table 1).

Of the total cases diagnosed at death, 60.3 percent (2,636) were 65 years of age or older. The observed proportion of cases diagnosed at death increased with age from 0.7 percent in patients less than 5 years old to 18.6 percent in patients 85 years and older. Adjustments for differences in race/ethnicity, sex, place of birth and disease

DISCUSSION

Over the four-year period from 1985 to 1988, 5.1 percent of nationally reported TB cases were diagnosed at death. The most important observation was that increasing age and site of disease (miliary, meningeal and peritoneal) were the variables most strongly associated with the likelihood that TB would be reported at death. That advanced age and site of disease were of overriding importance is best evidenced by the small changes in proportions of these two variables after adjustment for the

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Manuscript received August 20; revision accepted January 17.

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