Health-Related Quality of Life Trajectories Among Adults With Tuberculosis: Differences Between Latent and Active Infection

doi:10.1378/chest.07-1494

Chest

Volume 133, Issue 2, February 2008, Pages 396-403

https://doi.org/10.1378/chest.07-1494 Get rights and content

Background

Tuberculosis (TB) remains a public health threat with significant annual impacts on morbidity and mortality. However, few studies have examined the impact of active and latent TB infection (LTBI) on health-related quality of life (HRQL).

Methods

Patients with recently diagnosed active TB or LTBI patients were administered the Short Form-36 (SF-36) and the Beck depression inventory (DI) at baseline, 3 months, and 6 months. Mixed-effect linear regression was used to compare the trajectory of HRQL over time in the two patient groups after adjusting for potential confounders. Ordinal logistic regression was used to determine the relationship between changes in HRQL of at least the minimal important difference.

Results

One hundred four active TB and 102 LTBI patients participated. At baseline, participants with active TB had significantly lower SF-36 mean domain and component scores (4 to 12 points lower, p < 0.03) and higher mean Beck DI scores (4 points higher, p < 0.0001) when compared to LBTI participants. In the responder analysis, those with active TB were associated with reporting improved scores at 6 months of at least the minimal important difference in vitality (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.3 to 5.6), role physical (OR, 3.1; 95% CI, 1.4 to 6.5), mental component score (OR, 3.2; 95% CI, 1.5 to 6.9), social functioning (OR, 11.1; 95% CI, 3.8 to 33), and role emotional (OR, 2.7; 95% CI, 1.2 to 6.0).

Conclusions

Active TB patients had large improvements in most HRQL domains by 6 months. However, when compared to LTBI participants and US norms, HRQL was still low at completion of therapy.

Section snippets

Study Sample

Study subjects were recruited from the Provincial TB Clinic during 2005/2006. Ethics approval was obtained from the University of British Columbia Behavioral Research Ethics Board. Each subject provided signed, informed consent to participate in the study. Consecutive patients > 18 years of age with either LTBI or active TB disease were approached regarding entry into the study. Subjects were excluded for the following: (1) they were < 18 years old; (2) they were not receiving medication for

Results

In a consecutive fashion, over a 12-month period we approached 147 LTBI and 133 active TB patients to participate in the study. Of these, 119 LBTI and 114 active TB patients were deemed eligible and consented to participate in the study. Of these, 27 patients (17 LBTI and 7 active) withdrew from the study prior to completing the questionnaires. Subsequent to enrollment, three patients reported as having active TB were excluded because they did not fit the entry criteria of having active TB

Discussion

In this study, at the onset of treatment, participants with active TB had bigger deficits in HRQL than LTBI participants compared to US population norms. However, after 6 months of drug therapy, participants with active disease significantly improved in most domains of HRQL whereas those with LTBI did not. The domains that improved the most in active TB participants were vitality, physical functioning, role physical, social functioning, and role emotional. However, despite these significant

ACKNOWLEDGMENT

We thank Greg Stark, TB program nurse, for his aid in patient recruitment.

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This study was funded by a grant from the Canadian Society of Hospital Pharmacists. Dr. C. Marra is a Canada Research Chair in Pharmaceutical Outcomes as well as a Michael Smith Foundation for Health Research Scholar. Dr. Fitzgerald is a BC Lung CIHR Scientist and a Michael Smith Foundation for Health Research Distinguished Scholar.

The authors have no conflicts of interest to disclose.

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Chest

Original ResearchQuality of LifeHealth-Related Quality of Life Trajectories Among Adults With Tuberculosis: Differences Between Latent and Active Infection

Background

Methods

Results

Conclusions

Section snippets

Study Sample

Results

Discussion

ACKNOWLEDGMENT

Health Policy

J Subst Abuse Treat

Soc Sci Med

Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country

JAMA

Treatment of tuberculosis

Am J Respir Crit Care Med

Incidence of serious side effects from first-line antituberculosis drugs among patients treated for active tuberculosis

Am J Respir Crit Care Med

Attitudes regarding tuberculosis in immigrants from the Philippines to the United States

Fam Med

Isolation and stigma: the experience of patients with active tuberculosis

J Community Health Nurs

Depression, anxiety comorbidity and disability in tuberculosis and chronic obstructive pulmonary disease patients: applicability of GHQ-12

Gen Hosp Psychiatry

Original Research
Quality of Life
Health-Related Quality of Life Trajectories Among Adults With Tuberculosis: Differences Between Latent and Active Infection