Tuberculosis presentation and outcomes in elderly Hispanics from Tamaulipas, Mexico

Old people are at high risk of developing and dying from pulmonary infections like tuberculosis (TB), but they are few studies and particularly in Hispanics. To address these gaps, we sought to identify host factors associated with TB and adverse treatment outcomes in old Hispanics by conducting a secondary analysis of TB surveillance data from Tamaulipas, Mexico (2006-2013; n=8,381). Multivariable logistic regressions were assessed for the elderly (ELD, ≥65 years) when compared to young (YA, 18 to 39 years) and middle-aged adults (MAA, 40 to 64 years). We found that the ELD had features associated with a less complicated TB (e.g. less extra-pulmonary TB, abandoning of treatment or having drug resistant TB), and yet, were more likely to die during TB treatment (adj-OR 3.9, 95% 2.5, 5.25). Among the elderly, excess alcohol use and low BMI increased their odds of death, while diabetes and BCG vaccination were protective. These data suggest that old people share some, but not all the risk factors for adverse TB treatment outcomes, when compared with younger adults. Furthermore, even though old age in itself is an important predictor of death during TB, the elderly are not prioritized by the World Health Organization for latent TB infection screening and treatment during contact investigations. We propose the inclusion of the elderly as a high-risk group in TB management guidelines.