Short- and long-term increased risk of all-cause mortality in a tuberculosis cohort attributed to SARS-CoV-2 infection: a time-dependent survival analysis in ChileResearch in context
Summary: Background: Concurrent tuberculosis (TB) and COVID-19 increases the risk of mortality; however, most studies have focused primarily on short-term outcomes. We assessed the short and long-term impact of TB and SARS-CoV-2 coinfection on all-cause mortality. Methods: We conducted a retrospect...
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Elsevier
2025-06-01
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| Series: | The Lancet Regional Health. Americas |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667193X25001292 |
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| author | Vargas-García Salvador Eduardo A. Undurraga Nadia Escobar Christian García Natalia Vergara María Elvira Balcells |
| author_facet | Vargas-García Salvador Eduardo A. Undurraga Nadia Escobar Christian García Natalia Vergara María Elvira Balcells |
| author_sort | Vargas-García Salvador |
| collection | DOAJ |
| description | Summary: Background: Concurrent tuberculosis (TB) and COVID-19 increases the risk of mortality; however, most studies have focused primarily on short-term outcomes. We assessed the short and long-term impact of TB and SARS-CoV-2 coinfection on all-cause mortality. Methods: We conducted a retrospective nationwide cohort study in Chile, including adults diagnosed with active TB from January 1st, 2020, to December 31st, 2021, with follow-up until November 30th, 2022. SARS-CoV-2 coinfection was defined as occurring from 30 days before to six months after TB diagnosis. Short-term mortality was defined as death within 90 days of TB or TB/SARS-CoV-2 diagnosis, and long-term mortality as death occurring after 90 days. We used a time-dependent Cox survival analysis, adjusting for sociodemographic factors, SARS-CoV-2 vaccination, and relevant comorbidities including HIV, diabetes and Mycobacterium tuberculosis drug-resistance status. Findings: The cohort included 3721 adults (median age: 47 years, interquartile range [IQR]: 32–61); of whom 63·4% were male, and 79·4% had pulmonary TB. The median follow-up was 586 days (IQR: 401–820), with 680 deaths (18·3%) recorded. A SARS-CoV-2 coinfection was identified in 393 individuals (10·5%); the mortality in this group was higher in short-term (≤90 days: 14·5% vs. 11·4%) and long-term (>90 days: 11·5% vs. 5·9%) compared to TB alone. Coinfection increased the risk of all-cause mortality during the entire follow-up (aHR [adjusted Hazard Ratio]: 2·8, 95% CI: 2·26–3·47), over three-fold in the short-term (aHR 3·4, 95% CI: 2·57–4·51) and nearly two-fold in the long-term (aHR: 1·72, 95% CI: 1·18–2·52). Excess mortality persisted beyond the first year (aHR: 2·04, 95% CI: 1·09–3·82). SARS-CoV-2 vaccination reduced mortality risk in the TB cohort by 35% (95% CI: 19–46%). Interpretation: Tuberculosis and SARS-CoV-2 coinfection was associated with significantly increased all-cause mortality in both the short and long-term, with elevated risk persisting beyond TB treatment completion. These findings highlight the need for continued post-treatment follow-up and prioritization of SARS-CoV-2 vaccination among individuals with TB. Funding: ANID-FONDECYT, Chile, and CONAHCYT, Mexico. |
| format | Article |
| id | doaj-art-d9eb0315c5e94d098cf08bffb61a28b0 |
| institution | Kabale University |
| issn | 2667-193X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Americas |
| spelling | doaj-art-d9eb0315c5e94d098cf08bffb61a28b02025-08-20T03:53:13ZengElsevierThe Lancet Regional Health. Americas2667-193X2025-06-014610111910.1016/j.lana.2025.101119Short- and long-term increased risk of all-cause mortality in a tuberculosis cohort attributed to SARS-CoV-2 infection: a time-dependent survival analysis in ChileResearch in contextVargas-García Salvador0Eduardo A. Undurraga1Nadia Escobar2Christian García3Natalia Vergara4María Elvira Balcells5Department of Infectious Diseases, School of Medicine, Pontificia Universidad Católica de Chile, ChileEscuela de Gobierno, Pontificia Universidad Católica de Chile, Chile; Research Center for Integrated Disaster Risk Management (CIGIDEN), ChileNational Tuberculosis Control and Elimination Program, Ministry of Health, ChileDepartment of Epidemiology, Ministry of Health, ChileDepartment of Epidemiology, Ministry of Health, ChileDepartment of Infectious Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Chile; Corresponding author.Summary: Background: Concurrent tuberculosis (TB) and COVID-19 increases the risk of mortality; however, most studies have focused primarily on short-term outcomes. We assessed the short and long-term impact of TB and SARS-CoV-2 coinfection on all-cause mortality. Methods: We conducted a retrospective nationwide cohort study in Chile, including adults diagnosed with active TB from January 1st, 2020, to December 31st, 2021, with follow-up until November 30th, 2022. SARS-CoV-2 coinfection was defined as occurring from 30 days before to six months after TB diagnosis. Short-term mortality was defined as death within 90 days of TB or TB/SARS-CoV-2 diagnosis, and long-term mortality as death occurring after 90 days. We used a time-dependent Cox survival analysis, adjusting for sociodemographic factors, SARS-CoV-2 vaccination, and relevant comorbidities including HIV, diabetes and Mycobacterium tuberculosis drug-resistance status. Findings: The cohort included 3721 adults (median age: 47 years, interquartile range [IQR]: 32–61); of whom 63·4% were male, and 79·4% had pulmonary TB. The median follow-up was 586 days (IQR: 401–820), with 680 deaths (18·3%) recorded. A SARS-CoV-2 coinfection was identified in 393 individuals (10·5%); the mortality in this group was higher in short-term (≤90 days: 14·5% vs. 11·4%) and long-term (>90 days: 11·5% vs. 5·9%) compared to TB alone. Coinfection increased the risk of all-cause mortality during the entire follow-up (aHR [adjusted Hazard Ratio]: 2·8, 95% CI: 2·26–3·47), over three-fold in the short-term (aHR 3·4, 95% CI: 2·57–4·51) and nearly two-fold in the long-term (aHR: 1·72, 95% CI: 1·18–2·52). Excess mortality persisted beyond the first year (aHR: 2·04, 95% CI: 1·09–3·82). SARS-CoV-2 vaccination reduced mortality risk in the TB cohort by 35% (95% CI: 19–46%). Interpretation: Tuberculosis and SARS-CoV-2 coinfection was associated with significantly increased all-cause mortality in both the short and long-term, with elevated risk persisting beyond TB treatment completion. These findings highlight the need for continued post-treatment follow-up and prioritization of SARS-CoV-2 vaccination among individuals with TB. Funding: ANID-FONDECYT, Chile, and CONAHCYT, Mexico.http://www.sciencedirect.com/science/article/pii/S2667193X25001292Mycobacterium tuberculosisTuberculosisCOVID-19SARS-CoV-2Global healthCohort |
| spellingShingle | Vargas-García Salvador Eduardo A. Undurraga Nadia Escobar Christian García Natalia Vergara María Elvira Balcells Short- and long-term increased risk of all-cause mortality in a tuberculosis cohort attributed to SARS-CoV-2 infection: a time-dependent survival analysis in ChileResearch in context The Lancet Regional Health. Americas Mycobacterium tuberculosis Tuberculosis COVID-19 SARS-CoV-2 Global health Cohort |
| title | Short- and long-term increased risk of all-cause mortality in a tuberculosis cohort attributed to SARS-CoV-2 infection: a time-dependent survival analysis in ChileResearch in context |
| title_full | Short- and long-term increased risk of all-cause mortality in a tuberculosis cohort attributed to SARS-CoV-2 infection: a time-dependent survival analysis in ChileResearch in context |
| title_fullStr | Short- and long-term increased risk of all-cause mortality in a tuberculosis cohort attributed to SARS-CoV-2 infection: a time-dependent survival analysis in ChileResearch in context |
| title_full_unstemmed | Short- and long-term increased risk of all-cause mortality in a tuberculosis cohort attributed to SARS-CoV-2 infection: a time-dependent survival analysis in ChileResearch in context |
| title_short | Short- and long-term increased risk of all-cause mortality in a tuberculosis cohort attributed to SARS-CoV-2 infection: a time-dependent survival analysis in ChileResearch in context |
| title_sort | short and long term increased risk of all cause mortality in a tuberculosis cohort attributed to sars cov 2 infection a time dependent survival analysis in chileresearch in context |
| topic | Mycobacterium tuberculosis Tuberculosis COVID-19 SARS-CoV-2 Global health Cohort |
| url | http://www.sciencedirect.com/science/article/pii/S2667193X25001292 |
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