PULMONARY tuberculosis outcomes worsened in older patients with diabetes, kidney disease, malignancy, or multimorbidity.
Pulmonary Tuberculosis Outcomes in Older Adults
A high burden of comorbidity among older adults with pulmonary tuberculosis was linked to poorer treatment outcomes, according to a single-center retrospective cohort study of hospitalized patients aged 60 years and older.
The analysis included 1,340 patients with pulmonary tuberculosis treated between January 2020 and January 2024. Patients were grouped by World Health Organization outcome criteria into treatment success, reported in 1,105 patients, and adverse outcomes, reported in 235 patients. Adverse outcomes included treatment failure, death, and treatment termination.
Comorbidities were common, affecting 81.64% of patients. Nearly one-third had a single comorbidity, 26.64% had two comorbidities, 18.13% had three, and 6.19% had complex multimorbidity, defined as four or more coexisting conditions.
Comorbidity Burden Drives Clinical Risk
Chronic heart diseases were the most frequent comorbidity, occurring in 31.12% of patients, followed by chronic lung diseases in 27.84% and hypertension in 26.49%. Diabetes mellitus was present in 20.30% of patients, while psychiatric disorders affected 15.07%.
Overall, 17.54% of patients experienced an adverse outcome. This included treatment failure in 7.31%, death in 6.64%, and treatment termination in 3.58%. After propensity score matching and multivariate logistic regression, several conditions remained independently associated with adverse pulmonary tuberculosis outcomes.
Diabetes mellitus was associated with nearly threefold higher odds of adverse outcomes. Chronic kidney disease showed the strongest association, with more than sixfold higher odds. Active malignancy was also a significant risk factor, while multimorbidity, defined as three or more comorbidities, increased the odds of an adverse outcome by 71%.
Screening May Support Risk-Stratified Care
The findings highlight the clinical importance of early comorbidity screening in elderly patients with pulmonary tuberculosis. Identifying diabetes mellitus, chronic kidney disease, active malignancy, and multimorbidity at admission may help clinicians refine risk stratification and tailor monitoring during treatment.
The study also supports multidisciplinary management models for older adults with pulmonary tuberculosis, particularly when complex chronic disease may reduce treatment tolerance, complicate adherence, or increase mortality risk. While the retrospective, single-center design limits generalizability, the data emphasize that tuberculosis care in older adults should extend beyond infection control to include structured evaluation of coexisting disease burden.
Reference
Feng Y et al. Comorbidity profiles and their impact on treatment outcomes in elderly patients with pulmonary tuberculosis: a single-center retrospective cohort study. BMC Infect Dis. 2026;doi:10.1186/s12879-026-13459-4.
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