Factors associated with mortality from tuberculosis in Iran: An application of a generalized estimating equation-based zero-inflated negative binomial model to national registry data

Abstract

OBJECTIVES: Tuberculosis (TB) is a global public health problem that causes morbidity and mortality in millions of people per year. The purpose of this study was to examine the relationship of potential risk factors with TB mortality in Iran. METHODS: This cross-sectional study was performed on 9,151 patients with TB from March 2017 to March 2018 in Iran. Data were gathered from all 429 counties of Iran by the Ministry of Health and Medical Education and Statistical Center of Iran. In this study, a generalized estimating equation-based zero-inflated negative binomial model was used to determine the effect of related factors on TB mortality at the community level. For data analysis, R version 3.4.2 was used with the relevant packages. RESULTS: The risk of mortality from TB was found to increase with the unemployment rate (β=0.02), illiteracy (β=0.04), household density per residential unit (β=1.29), distance between the center of the county and the provincial capital (β=0.03), and urbanization (β=0.81). The following other risk factors for TB mortality were identified: Diabetes (β=0.02), human immunodeficiency virus infection (β=0.04), infection with TB in the most recent 2 years (β=0.07), injection drug use (β=0.07), long-term corticosteroid use (β=0.09), malignant diseases (β=0.09), chronic kidney disease (β=0.32), gastrectomy (β=0.50), chronic malnutrition (β=0.38), and a body mass index more than 10% under the ideal weight (β=0.01). However, silicosis had no effect. CONCLUSIONS: The results of this study provide useful information on risk factors for mortality from TB. rel.