Long-Term Mortality of Tuberculosis Survivors in Korea: A Population-based Longitudinal Study

Abstract Background When assessing long-term tuberculosis (TB) mortality, few studies addressed the impact of behavior habits and socioeconomic status. Therefore, we aimed to evaluate long-term TB mortality and risk factors while accounting for potential confounders. Methods This cohort study included TB survivors (n = 82 098) aged ≥20 years between 2010 and 2017, and 1:1 age- and sex-matched controls (n = 82 098). The participants were followed up for death 1 year after study enrollment until December 2018. Long-term mortality was adjusted for behavior habits (smoking, alcohol consumption, or exercise), income level, body mass index (BMI), and comorbidities. Results During a median of 3.7 years of follow-up, the incidence rate of mortality was significantly higher in TB survivors than those in the matched controls (18.2 vs. 8.8 per 1000 person-years, P < .001). Even after adjusting for potential confounders, the mortality risk was 1.62-fold (95% confidence interval [CI], 1.54–1.70) higher in TB survivors than those in the matched controls. In addition, the hazard of mortality in TB survivors relative to matched controls significantly increased in participants aged ≥30 years, with the highest risk in those in their 40s. Male sex (adjusted hazard ratio [HR]: 2.31; 95% CI, 2.16–2.47), smoking pack-years (HR: 1.005; 95% CI, 1.004–1.006), heavy alcohol consumption (HR: 1.12; 95% CI, 1.01–1.23), and lowest income (HR: 1.27; 95% CI, 1.18–1.37) were positively associated with increased hazards for mortality, whereas higher BMI (HR: 0.91; 95% CI, .90–.92) and regular exercise (HR: 0.82; 95% CI, .76–.88) reduced the hazards of long-term mortality in TB survivors. Conclusions The long-term mortality risk was significantly higher in TB survivors than those in the matched controls, even after adjusting for potential confounders.