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首页> 外文期刊>Journal of public health management and practice: JPHMP >Factors Associated With Latent Tuberculosis Infection Treatment Failure Among Patients With Commercial Health Insurance—United States, 2005-2016
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Factors Associated With Latent Tuberculosis Infection Treatment Failure Among Patients With Commercial Health Insurance—United States, 2005-2016

机译：与商业健康保险患者潜在结核病感染治疗失败相关的因素，2005-2016

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Supplemental Digital Content is Available in the Text. Context: Approximately 80% of US tuberculosis (TB) cases verified during 2015-2016 were attributed to untreated latent TB infection (LTBI). Identifying factors associated with LTBI treatment failure might improve treatment effectiveness. Objective: To identify patients with indicators of isoniazid (INH) LTBI treatment initiation, completion, and failure. Methods: We searched inpatient and outpatient claims for International Classification of Diseases ( Ninth and Tenth Revisions ), National Drug, and Current Procedural Terminology codes. We defined treatment completion as 180 days or more of INH therapy during a 9-month period. We defined LTBI treatment failure as an active TB disease diagnosis more than 1 year after starting LTBI treatment among completers and used exact logistic regression to model possible differences between groups. Among treatment completers, we matched 1 patient who failed treatment with 2 control subjects and fit regression models with covariates documented on medical claims paid 6 months or less before INH treatment initiation. Participants: Commercially insured US patients in a large commercial database with insurance claims paid during 2005-2016. Main Outcome Measures: (1) Trends in treatment completion; (2) odds ratios (ORs) for factors associated with treatment completion and treatment failure. Results: Of 21 510 persons who began LTBI therapy during 2005-2016, 10 725 (49.9%) completed therapy. Treatment noncompletion is associated with those younger than 45 years, living in the Northeast or South Census regions, and women. Among persons who completed treatment, 30 (0.3%) progressed to TB disease. Diagnoses of rheumatoid arthritis during the 6 months before treatment initiation and being aged 65 years or older (reference: ages 0-24 years) were significantly associated with INH LTBI treatment failure (adjusted exact OR = 5.1; 95% CI, 1.2-28.2; and adjusted exact OR = 5.1; 95% CI, 1.2-25.3, respectively). Conclusion: Approximately 50% of persons completed INH LTBI therapy, and of those, treatment failure was associated with rheumatoid arthritis and persons 65 years or older among a cohort of US LTBI patients with commercial health insurance.
机译：文本中提供了补充数字内容。背景：2015-2016年期间，约80%的美国结核病（TB）确诊病例归因于未经治疗的潜伏性结核感染（LTBI）。识别与LTBI治疗失败相关的因素可能会提高治疗效果。目的：确定异烟肼（INH）LTBI治疗开始、完成和失败的患者指标。方法：我们搜索了《国际疾病分类》（第九版和第十版）、国家药品和现行程序术语代码的住院和门诊索赔。我们将治疗完成定义为9个月内180天或以上的INH治疗。我们将LTBI治疗失败定义为在完成LTBI治疗的患者中开始LTBI治疗超过1年后的活动性结核病诊断，并使用精确的逻辑回归来模拟组间可能存在的差异。在治疗完成者中，我们将1名治疗失败的患者与2名对照受试者进行配对，并将回归模型与记录在INH治疗开始前6个月或更短时间内支付的医疗索赔的协变量进行拟合。参与者：大型商业数据库中的美国商业保险患者，在2005-2016年间支付了保险索赔。主要观察指标：（1）治疗完成的趋势；（2） 与治疗完成和治疗失败相关因素的优势比（OR）。结果：在2005-2016年间开始LTBI治疗的21510人中，10725人（49.9%）完成了治疗。治疗不完全与45岁以下、居住在东北或南部普查地区的人和女性有关。在完成治疗的人中，30人（0.3%）进展为结核病。在治疗开始前的6个月内，年龄在65岁或以上（参考文献：年龄0-24岁）的类风湿性关节炎诊断与INH-LTBI治疗失败显著相关（调整后精确or=5.1；95%可信区间1.2-28.2；调整后精确or=5.1；95%可信区间1.2-25.3）。结论：在有商业医疗保险的美国LTBI患者队列中，大约50%的人完成了INH LTBI治疗，其中治疗失败与类风湿性关节炎和65岁或以上的人有关。

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