Clinical impact of the coronavirus disease 2019 pandemic on the quality of pulmonary tuberculosis management with national reimbursement data in Korea: a retrospective cohort study
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Backgrounds: The coronavirus disease 2019 (COVID-19) pandemic has retreated the years ofprogress that essential tuberculosis (TB) medical services provided in reducing the burden ofTB. This study evaluated the clinical impact of the COVID-19 pandemic on TB managementbased on treatment discontinuation and mortality rates. Methods: Two time intervals were included in this study: before the spread of COVID-19(2018–2019) and during the pandemic phase of COVID-19 (2020–2021). Newly diagnosedpatients with pulmonary TB (42,930 before and 32,094 during COVID-19) were included usingthe national reimbursement data from the health insurance service in Korea. Treatmentdiscontinuation was defined as the discontinuation of treatment for more than 2 weeksduring the initial intensive care phase or for more than 2 months during the maintenancephase. Mortality rates were compared before the spread and during the pandemic phase ofCOVID-19 in all patients and subgroups with various comorbidities. The Kaplan–Meier survivalcurve for each group of study participants was derived, and collective statistical significancewas confirmed using the log-rank test. Results: The treatment discontinuation rate over the entire period showed a trend ofdecreasing the time factor (-0.0084), decreasing the level change (-0.0166), and increasingthe intersection term (0.0039). These tendencies were similar during the initial intensivecare and maintenance treatment periods, suggesting that the decreasing trend over timewas significant, but the level change and slope change before the spread and during thepandemic phase of COVID-19 were not in agreement. The total mortality rates increased moreduring the COVID-19 pandemic (14.6% increase after 1 year and 18.9% increase after 2 years,based on 2020) than before COVID-19 (12.3% increase after 1 year and 16.1% increase after 2years, based on 2018). Regarding the impact of comorbidities on TB mortality, malnutritionand diabetes showed a strong impact on the mortality with more than 2 of relative risks bothin 1-year and 2-year mortalities. Conclusion: This study verified the clinical impact of the COVID-19 pandemic on TBmanagement. Therefore, establishing appropriate TB management policies is urgentlyneeded for the future COVID-19-like pandemic situation.
Abstract
Backgrounds: The coronavirus disease 2019 (COVID-19) pandemic has retreated the years ofprogress that essential tuberculosis (TB) medical services provided in reducing the burden ofTB. This study evaluated the clinical impact of the COVID-19 pandemic on TB managementbased on treatment discontinuation and mortality rates. Methods: Two time intervals were included in this study: before the spread of COVID-19(2018–2019) and during the pandemic phase of COVID-19 (2020–2021). Newly diagnosedpatients with pulmonary TB (42,930 before and 32,094 during COVID-19) were included usingthe national reimbursement data from the health insurance service in Korea. Treatmentdiscontinuation was defined as the discontinuation of treatment for more than 2 weeksduring the initial intensive care phase or for more than 2 months during the maintenancephase. Mortality rates were compared before the spread and during the pandemic phase ofCOVID-19 in all patients and subgroups with various comorbidities. The Kaplan–Meier survivalcurve for each group of study participants was derived, and collective statistical significancewas confirmed using the log-rank test. Results: The treatment discontinuation rate over the entire period showed a trend ofdecreasing the time factor (-0.0084), decreasing the level change (-0.0166), and increasingthe intersection term (0.0039). These tendencies were similar during the initial intensivecare and maintenance treatment periods, suggesting that the decreasing trend over timewas significant, but the level change and slope change before the spread and during thepandemic phase of COVID-19 were not in agreement. The total mortality rates increased moreduring the COVID-19 pandemic (14.6% increase after 1 year and 18.9% increase after 2 years,based on 2020) than before COVID-19 (12.3% increase after 1 year and 16.1% increase after 2years, based on 2018). Regarding the impact of comorbidities on TB mortality, malnutritionand diabetes showed a strong impact on the mortality with more than 2 of relative risks bothin 1-year and 2-year mortalities. Conclusion: This study verified the clinical impact of the COVID-19 pandemic on TBmanagement. Therefore, establishing appropriate TB management policies is urgentlyneeded for the future COVID-19-like pandemic situation.