Abstract
Factors Associated with Latent Tuberculosis Infection Treatment Failure Among Patients with Commercial Health Insurance — United States, 2005–2016
APHA's 2019 Annual Meeting and Expo (Nov. 2 - Nov. 6)
Objective: To identify LTBI treatment failure–associated factors among a cohort of US patients with insurance claims paid during 2005–2016 by using a large insurance claims database.
Methods: We searched inpatient and outpatient claims for International Classification of Diseases (9th and 10th revisions), National Drug, and Current Procedural Terminology codes to identify patients with indicators of isoniazid (INH) LTBI treatment initiation, completion, and failure. We defined treatment completion as ≥180 or ≥270 days of INH during a 9- or 12-month period, respectively. We defined LTBI treatment failure as tuberculosis disease (TB) diagnosis >1 year after starting LTBI treatment among treatment completers. We matched 1 treatment failure patient with 2 control subjects and fit conditional logistic regression models with covariates that included comorbidities documented on medical claims paid ≤6 months before INH treatment initiation.
Results: Of 21,510 persons who began LTBI therapy during 2005–2016, 49.9% completed therapy. By treatment completion, 44 (0.4%) noncompleters and 30 (0.3%) completers progressed to TB (odds ratio [OR], 1.5; 95% confidence interval [CI], 0.9–2.3). The median time for treatment failure from initiation, regardless of treatment completion, was 1.8 years. Diagnoses of rheumatoid arthritis during the 6 months before treatment initiation was significantly associated with LTBI treatment failure (adjusted conditional OR, 3.5; 95% CI, 1.1–11.7).
Conclusion: LTBI treatment failure was associated with rheumatoid arthritis among a cohort of US LTBI patients with commercial health insurance.
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