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Health-Related Quality of Life Trajectories Among Adults With Tuberculosis^*

Differences Between Latent and Active Infection

^* From the Collaboration for Outcomes Research and Evaluation (Dr. C. Marra and Ms. Colley), Faculty of Pharmaceutical Sciences (Dr. F. Marra), University of British Columbia; Pharmacy and Vaccine Services (Dr. Moadebi) and Division of Tuberculosis Control (Dr. Elwood), British Columbia Centre for Disease Control; and Division of Respiratory Medicine (Dr. Fitzgerald), Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.

Correspondence to: Carlo Marra, BSc, PharmD, PhD, Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, 620B-1081 Burrard St, Vancouver, BC, V6Z 1Y6 Canada; e-mail: carlo.marra{at}ubc.ca

Abstract

Background: Tuberculosis (TB) remains a public health threat with significant annual impacts on morbidity and mortality. However, few studies have examined the impact of active and latent TB infection (LTBI) on health-related quality of life (HRQL).

Methods: Patients with recently diagnosed active TB or LTBI patients were administered the Short Form-36 (SF-36) and the Beck depression inventory (DI) at baseline, 3 months, and 6 months. Mixed-effect linear regression was used to compare the trajectory of HRQL over time in the two patient groups after adjusting for potential confounders. Ordinal logistic regression was used to determine the relationship between changes in HRQL of at least the minimal important difference.

Results: One hundred four active TB and 102 LTBI patients participated. At baseline, participants with active TB had significantly lower SF-36 mean domain and component scores (4 to 12 points lower, p < 0.03) and higher mean Beck DI scores (4 points higher, p < 0.0001) when compared to LBTI participants. In the responder analysis, those with active TB were associated with reporting improved scores at 6 months of at least the minimal important difference in vitality (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.3 to 5.6), role physical (OR, 3.1; 95% CI, 1.4 to 6.5), mental component score (OR, 3.2; 95% CI, 1.5 to 6.9), social functioning (OR, 11.1; 95% CI, 3.8 to 33), and role emotional (OR, 2.7; 95% CI, 1.2 to 6.0).

Conclusions: Active TB patients had large improvements in most HRQL domains by 6 months. However, when compared to LTBI participants and US norms, HRQL was still low at completion of therapy.

Key Words: health-related quality of life • Short Form-36 • tuberculosis