Disability Inequality in Short- and Long-Term Mortality After Multidrug-Resistant Tuberculosis

Background

The impact of disability on mortality in multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) remains unclear despite the recognized vulnerability of individuals with disabilities.

Methods

We conducted a nationwide population-based retrospective cohort study using linked national databases. Individuals diagnosed with MDR/RR-TB between 2008 and 2019 were followed until death or December 2022. Short-term mortality was defined as death within two years after diagnosis, and long-term mortality was assessed among individuals who survived beyond two years using a landmark analysis. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for the associations between disability status and both short-term and long-term mortality.

Results

Among 11,292 individuals with MDR/RR-TB, 1,237 (11.0%) had registered disabilities. During the first two years after diagnosis, mortality was higher among individuals with disabilities than those without (15.8% vs. 5.9%, P < 0.001), corresponding to incidence rates of 87.0 and 30.5 per 1,000 person-years, respectively. Disability remained associated with increased short-term mortality after adjustment (aHR, 1.42; 95% CI, 1.20–1.67). Among individuals who survived at least two years, long-term mortality was also substantially higher in those with disabilities (40.2% vs. 17.0%, P < 0.001), with incidence rates of 56.0 and 19.9 per 1,000 person-years, respectively. Disability was strongly associated with long-term mortality (aHR, 2.81; 95% CI, 2.52–3.13), with higher risks observed across disability severity and specific disability types.

Conclusions

Disability is associated with significantly increased mortality during both treatment and post-treatment phases of MDR/RR-TB. These findings support disability-inclusive, patient-centred care across both treatment and post-treatment phases.

Key messages

• Disability was associated with substantially higher mortality among individuals with MDR/RR-TB, both within two years after diagnosis and among those who survived beyond two years.

• MDR/RR-TB care should incorporate disability status into risk assessment and extend beyond microbiological cure through long-term, patient-centred strategies for this vulnerable population.