Mortality of tuberculosis patients during treatment in Israel, 2000-2010.

SETTING Tuberculosis (TB) epidemiology in Israel is similar to that reported from other industrialised countries where most patients are foreign-born. OBJECTIVES To assess TB case fatality rate (CFR) and mortality trends during treatment and to identify risk factors associated with mortality. DESIGN Retrospective cohort study of all TB patients in Israel diagnosed between 2000 and 2010. Cause of death was classified by TB-specific and non-TB-specific causes. RESULTS During the study period, 451 TB patients died during treatment, representing a CFR of 9.9%. Of these, 72.5% died due to TB-related causes, giving a TB-related CFR of 7.2%. Both the overall and TB-related CFR decreased over the study period. Risk factors for death included male sex, older age, human immunodeficiency virus coinfection, culture positivity and multidrug-resistant TB (MDR-TB). Patients aged ≥65 years comprised 70% of the TB-related deaths, and more than half of these (54.9%) were born in the former Soviet Union, Europe (excluding the former Soviet Union) or the USA. CONCLUSION Both the overall and TB-related CFR decreased over the study period. Physicians who treat older male TB patients with MDR-TB or HIV should increase the index of suspicion to include the possibility of a higher risk of mortality.