Autopsy protocols for 1989-1994 have been analyzed for 123 patients with pulmonary tuberculosis. Within the first year after the disease registration one-sixth of the patients died. Most of them were males over 50 living in rural regions. Dominating were different forms of destructive pulmonary tuberculosis running concurrently with circulatory, respiratory, gastrointestinal diseases, alcoholism, diabetes mellitus.
The outpatient medical cards and history cases of those who died, autopsy protocols of 428 dead patients with various forms of tuberculosis were analyzed. Of them, 86 patients had been followed up less than a year. The patients treated with antituberculous drugs died not only from a progressive specific process, but from nonspecific complications. The factors predisposing to death were late detection of tuberculosis and irregular treatment, alcohol and drug abuse.
Among the deceased in the Sverdlovsk Region in 1995 - 1996 there was a larger proportion of males and individuals aged over 40 years, unemployed, homeless persons, patients with infiltrative pulmonary tuberculosis, concomitant diseases and a smaller proportion of those with prolonged pulmonary tuberculosis, its fibrocavernous type, persons who died from secondary nonspecific changes and complications of the tuberculosis process. Today the most common causes of premature death due to tuberculosis are in patients' refusal of treatment, systemic incompliance, a severe concomitant disease, contraindications for surgical treatment, drug resistance to tuberculostatic agents, drug shortage, late referral for medical aid and long-term evasion of prophylactic surveys for tuberculosis.
Avoidable mortality has been proposed as an outcome measure of health services and our aim, in this study, is to trace its general features and regional variations in Québec. For that purpose, comparisons are established between two time periods (1969-73 and 1982-90) and with several countries. Furthermore, regional SMRs (for the period 1982-90) are submitted to the Gail heterogeneity test and introduced in a stepwise regression with variables describing health services, socio-economic context and prevalence or incidence of related diseases. An analysis of proportional mortality is carried out in the two northern regions of Kativik and Baie-James. Avoidable mortality has dropped substantially in Québec, except in the case of asthma, and now displays excellent scores at the international level. Only three causes of death show significant regional variations: tuberculosis, hypertensive and cerebrovascular diseases and perinatal mortality. These variations are mainly associated with socio-economic factors but also with health services. Furthermore, the highest rates of avoidable death have been observed in Gaspésie, Saguenay/Lac St-Jean and in the two northern regions. These results are discussed through information already available on health services in Québec.
SETTING: Tuberculosis (TB) incidence and mortality in Russia have risen dramatically over the past 15 years. OBJECTIVE: To identify risk factors and causes of death among TB patients in Russia. DESIGN: A retrospective study conducted to determine the risk factors and causes of death in patients receiving TB therapy in Tomsk, Siberia. RESULTS: Of 1916 patients who initiated treatment between 1 January 2002 and 31 December 2003, 183 (9.6%) died during treatment, 38 (21%) in the first week of therapy. Twenty-five per cent of deaths were not directly attributable to TB. Risk factors for death included older age, previous treatment for TB, multidrug resistance and alcoholism. CONCLUSIONS: The high death rate during TB treatment observed in this cohort likely reflects an increased risk of dying not only from TB, but also from comorbid conditions, such as alcoholism and cardiovascular disease. Overall, alcoholism and late presentation both contributed substantially to the mortality in this cohort.
In the Sverdlovsk Region, the main reason of death from tuberculosis is a fibrocavernous pulmonary process (51.8%) that is most commonly detected in the postportem diagnosis of tuberculosis (61.9%). Before death, patients with fibrocavernous tuberculosis do not ask for medical aid frequently (73.4%). In the first-year follow-up, most deceased persons come to health care facilities 3 months or more after the occurrence of significant clinical symptoms (60.8%). The refusals of patients to receive in- and outpatient therapy, multiple discharges from hospital due to their incompliance, following by long-term therapy discontinuance, which led to secondary multidrug resistance, were responsible for progressive tuberculosis that was the main cause of death from a fibrocavernous process.