Mortality before or during treatment among tuberculosis patients in North Carolina, 1993-2003.

Despite effective therapy, tuberculosis (TB) associated mortality remains relatively high, with 8.3 million new TB cases and 1.8 million TB deaths worldwide in 2000.1 Many of those patients died prior to TB diagnosis or during treatment.2 Frequently reported predictors of mortality during TB treatment include TB-HIV (human immunodeficiency virus) co-infection,3-8 previous TB treatment,9-11 low weight,12,13 older age8,9,11,14-17 and alcoholism.8,10,11,15 More recently, diabetes14,18 and tobacco smoking19 have been associated with TB mortality. Causes of TB-related mortality vary widely, with deaths reported to be from malignancy,8 pneumonia20,21 and respiratory failure,21 in addition to death attributed directly to TB itself.14,16,20 The state of North Carolina is in the southeastern United States, an area with the highest percentage of households with incomes below the federal poverty level of any region in the country.22 It differs from urban populations usually studied in the United States, as it comprises a predominantly rural population whose source of health care is geographically scattered. We set out to determine the demographic and behavioral risk factors associated with death prior to or during TB treatment among TB patients in North Carolina during 1993–2003.