Sex differences in risk factors for unsuccessful tuberculosis treatment outcomes in Eastern Europe from 2020 to 2022: a multi-country retrospective cohort studyResearch in context
Summary: Background: Addressing the disproportionate representation between sexes is essential for achieving universal health coverage. Studies on the association between sex and unsuccessful tuberculosis treatment outcomes have shown conflicting results. This study examines this association and an...
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2025-08-01
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| Series: | The Lancet Regional Health. Europe |
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| author | Ole Skouvig Pedersen Tetiana Butova Valerii Miasoiedov Yurii Feshchenko Mykhailo Kuzhko Stefan Niemann Alex Rosenthal Alina Grinev Gabriel Rosenfeld Michael Drew Hoppes Julia Kilmnick Valeriu Crudu Nelly Ciobanu Alexandru Codreanu Bekzat Toxanbayeva Lyailya Chingissova Kateryna Yurko Valerii Kucheriavchenko Vitalii Vekshyn Sergo Vashakidze Natalia Shubladze Zaza Avaliani Abdullaat Kadyrov Gulmira Kalmambetova Merbubu Sydykova Eugenia Ghita Victor Ionel Grecu Alina Marinela Miulescu Christian Morberg Wejse Andreas Fløe Victor Naestholt Dahl Dmytro Butov |
| author_facet | Ole Skouvig Pedersen Tetiana Butova Valerii Miasoiedov Yurii Feshchenko Mykhailo Kuzhko Stefan Niemann Alex Rosenthal Alina Grinev Gabriel Rosenfeld Michael Drew Hoppes Julia Kilmnick Valeriu Crudu Nelly Ciobanu Alexandru Codreanu Bekzat Toxanbayeva Lyailya Chingissova Kateryna Yurko Valerii Kucheriavchenko Vitalii Vekshyn Sergo Vashakidze Natalia Shubladze Zaza Avaliani Abdullaat Kadyrov Gulmira Kalmambetova Merbubu Sydykova Eugenia Ghita Victor Ionel Grecu Alina Marinela Miulescu Christian Morberg Wejse Andreas Fløe Victor Naestholt Dahl Dmytro Butov |
| author_sort | Ole Skouvig Pedersen |
| collection | DOAJ |
| description | Summary: Background: Addressing the disproportionate representation between sexes is essential for achieving universal health coverage. Studies on the association between sex and unsuccessful tuberculosis treatment outcomes have shown conflicting results. This study examines this association and analyses sex-stratified risk factors associated with unsuccessful outcomes. Methods: This retrospective, observational cohort study analysed prospectively collected data from six Eastern European countries from 2020 to 2022. Treatment outcomes were defined using World Health Organization criteria. Uni- and multivariable logistic regression models were used to assess the association between sex and unsuccessful outcomes (‘treatment failure’, ‘lost to follow-up’, ‘died’, or any of these). After propensity score matching females and males, the multivariable analysis was repeated. Risk factors were analysed separately for each sex and compared using interaction terms. Findings: Among females, 19·5% (n = 290/1490) (95% confidence interval [CI]: 18, 22) achieved an unsuccessful treatment outcome, compared with 30% (n = 1363/4553) (95% CI: 29, 31) among males. In the multivariable analyses, female sex was associated with 32% lower odds of any unsuccessful outcome (adjusted odds ratio [aOR] 0·68, 95% CI: 0·58, 0·80), 36% lower odds of dying (aOR 0·64, 95% CI: 0·51, 0·80), and 37% lower odds of treatment failure (aOR 0·63, 95% CI: 0·47, 0·85). The association between sex and being ‘lost to follow-up’ was not significant. In the propensity score-matched cohort, sex was not associated with unsuccessful outcomes. Risk factors for unsuccessful outcomes were similar for females and males, except that in females aged >65 years, the odds of death were 2·2 times higher (95% CI: 1·1, 4·4). Interpretation: Male sex was associated with unsuccessful outcomes, including death and treatment failure, but adjusting for socio-demographic and clinical factors, and matching males to females, attenuated the association, suggesting that sex disparities in tuberculosis outcomes may be driven more by behavioural than biological factors. Longitudinal studies are needed to confirm these findings. Funding: The publication fee was funded by the Civilian Research and Development Foundation (CRDF) under grant #G-202407-72538. |
| format | Article |
| id | doaj-art-f08bc5e3f4124bd5bb78bafc8b642d53 |
| institution | Kabale University |
| issn | 2666-7762 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Europe |
| spelling | doaj-art-f08bc5e3f4124bd5bb78bafc8b642d532025-08-20T03:30:30ZengElsevierThe Lancet Regional Health. Europe2666-77622025-08-015510135410.1016/j.lanepe.2025.101354Sex differences in risk factors for unsuccessful tuberculosis treatment outcomes in Eastern Europe from 2020 to 2022: a multi-country retrospective cohort studyResearch in contextOle Skouvig Pedersen0Tetiana Butova1Valerii Miasoiedov2Yurii Feshchenko3Mykhailo Kuzhko4Stefan Niemann5Alex Rosenthal6Alina Grinev7Gabriel Rosenfeld8Michael Drew Hoppes9Julia Kilmnick10Valeriu Crudu11Nelly Ciobanu12Alexandru Codreanu13Bekzat Toxanbayeva14Lyailya Chingissova15Kateryna Yurko16Valerii Kucheriavchenko17Vitalii Vekshyn18Sergo Vashakidze19Natalia Shubladze20Zaza Avaliani21Abdullaat Kadyrov22Gulmira Kalmambetova23Merbubu Sydykova24Eugenia Ghita25Victor Ionel Grecu26Alina Marinela Miulescu27Christian Morberg Wejse28Andreas Fløe29Victor Naestholt Dahl30Dmytro Butov31Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, DenmarkOutpatient Department, Merefa Central District Hospital, Merefa, UkraineKharkiv National Medical University, Kharkiv, UkraineNational Scientific Center of Phthisiatry, Pulmonology and Allergology named after F. G. Yanovskyi, National Academy of Medical Sciences of Ukraine, Kyiv, UkraineNational Scientific Center of Phthisiatry, Pulmonology and Allergology named after F. G. Yanovskyi, National Academy of Medical Sciences of Ukraine, Kyiv, UkraineMolecular and Experimental Mycobacteriology Group, Research Center Borstel, Borstel, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany; EPHE, PSL University, Paris, France; Institut de Systématique, Évolution, Biodiversité (ISYEB), Muséum national d’Histoire naturelle, CNRS, Sorbonne Université, EPHE, Université des Antilles, Paris, FranceOffice of Cyber Infrastructure and Computational Biology, U.S. National Institute of Allergy and Infectious Diseases, Rockville, MD, USAOffice of Cyber Infrastructure and Computational Biology, U.S. National Institute of Allergy and Infectious Diseases, Rockville, MD, USAOffice of Cyber Infrastructure and Computational Biology, U.S. National Institute of Allergy and Infectious Diseases, Rockville, MD, USAOffice of Cyber Infrastructure and Computational Biology, U.S. National Institute of Allergy and Infectious Diseases, Rockville, MD, USAOffice of Cyber Infrastructure and Computational Biology, U.S. National Institute of Allergy and Infectious Diseases, Rockville, MD, USANational TB Reference Laboratory, Institute of Phthisiopneumology, Chisinau, MoldovaNational TB Reference Laboratory, Institute of Phthisiopneumology, Chisinau, MoldovaNational TB Reference Laboratory, Institute of Phthisiopneumology, Chisinau, MoldovaNational Reference Laboratory, National Scientific Center of Phthisiopulmonology, Almaty, KazakhstanNational Center for TB and Lung Diseases, Tbilisi, GeorgiaKharkiv National Medical University, Kharkiv, UkraineKharkiv National Medical University, Kharkiv, UkraineKharkiv National Medical University, Kharkiv, UkraineNational Center for TB and Lung Diseases, Tbilisi, Georgia; The University of Georgia, Tbilisi, GeorgiaNational Center for TB and Lung Diseases, Tbilisi, GeorgiaNational Center for TB and Lung Diseases, Tbilisi, Georgia; European University, Tbilisi, GeorgiaNational Tuberculosis Center, Bishkek, Kyrgyz RepublicNational Tuberculosis Center, Bishkek, Kyrgyz RepublicNational Tuberculosis Center, Bishkek, Kyrgyz RepublicSpirans Association, Bucharest, RomaniaTB Ambulatory, Victor Babes Clinical Hospital for Infectious Disease and Pneumophthisiology, Craiova, RomaniaIIIrd Pneumo-Phthisiology Ward, Leamna Phthisiology Hospital, Bucovat, RomaniaDepartment of Infectious Diseases, Aarhus University Hospital, Aarhus, DenmarkDepartment of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, DenmarkDepartment of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; Corresponding author.Kharkiv National Medical University, Kharkiv, Ukraine; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, GermanySummary: Background: Addressing the disproportionate representation between sexes is essential for achieving universal health coverage. Studies on the association between sex and unsuccessful tuberculosis treatment outcomes have shown conflicting results. This study examines this association and analyses sex-stratified risk factors associated with unsuccessful outcomes. Methods: This retrospective, observational cohort study analysed prospectively collected data from six Eastern European countries from 2020 to 2022. Treatment outcomes were defined using World Health Organization criteria. Uni- and multivariable logistic regression models were used to assess the association between sex and unsuccessful outcomes (‘treatment failure’, ‘lost to follow-up’, ‘died’, or any of these). After propensity score matching females and males, the multivariable analysis was repeated. Risk factors were analysed separately for each sex and compared using interaction terms. Findings: Among females, 19·5% (n = 290/1490) (95% confidence interval [CI]: 18, 22) achieved an unsuccessful treatment outcome, compared with 30% (n = 1363/4553) (95% CI: 29, 31) among males. In the multivariable analyses, female sex was associated with 32% lower odds of any unsuccessful outcome (adjusted odds ratio [aOR] 0·68, 95% CI: 0·58, 0·80), 36% lower odds of dying (aOR 0·64, 95% CI: 0·51, 0·80), and 37% lower odds of treatment failure (aOR 0·63, 95% CI: 0·47, 0·85). The association between sex and being ‘lost to follow-up’ was not significant. In the propensity score-matched cohort, sex was not associated with unsuccessful outcomes. Risk factors for unsuccessful outcomes were similar for females and males, except that in females aged >65 years, the odds of death were 2·2 times higher (95% CI: 1·1, 4·4). Interpretation: Male sex was associated with unsuccessful outcomes, including death and treatment failure, but adjusting for socio-demographic and clinical factors, and matching males to females, attenuated the association, suggesting that sex disparities in tuberculosis outcomes may be driven more by behavioural than biological factors. Longitudinal studies are needed to confirm these findings. Funding: The publication fee was funded by the Civilian Research and Development Foundation (CRDF) under grant #G-202407-72538.http://www.sciencedirect.com/science/article/pii/S2666776225001462TuberculosisTreatment outcomeSexHealthcareSocioeconomic factorsGender and health |
| spellingShingle | Ole Skouvig Pedersen Tetiana Butova Valerii Miasoiedov Yurii Feshchenko Mykhailo Kuzhko Stefan Niemann Alex Rosenthal Alina Grinev Gabriel Rosenfeld Michael Drew Hoppes Julia Kilmnick Valeriu Crudu Nelly Ciobanu Alexandru Codreanu Bekzat Toxanbayeva Lyailya Chingissova Kateryna Yurko Valerii Kucheriavchenko Vitalii Vekshyn Sergo Vashakidze Natalia Shubladze Zaza Avaliani Abdullaat Kadyrov Gulmira Kalmambetova Merbubu Sydykova Eugenia Ghita Victor Ionel Grecu Alina Marinela Miulescu Christian Morberg Wejse Andreas Fløe Victor Naestholt Dahl Dmytro Butov Sex differences in risk factors for unsuccessful tuberculosis treatment outcomes in Eastern Europe from 2020 to 2022: a multi-country retrospective cohort studyResearch in context The Lancet Regional Health. Europe Tuberculosis Treatment outcome Sex Healthcare Socioeconomic factors Gender and health |
| title | Sex differences in risk factors for unsuccessful tuberculosis treatment outcomes in Eastern Europe from 2020 to 2022: a multi-country retrospective cohort studyResearch in context |
| title_full | Sex differences in risk factors for unsuccessful tuberculosis treatment outcomes in Eastern Europe from 2020 to 2022: a multi-country retrospective cohort studyResearch in context |
| title_fullStr | Sex differences in risk factors for unsuccessful tuberculosis treatment outcomes in Eastern Europe from 2020 to 2022: a multi-country retrospective cohort studyResearch in context |
| title_full_unstemmed | Sex differences in risk factors for unsuccessful tuberculosis treatment outcomes in Eastern Europe from 2020 to 2022: a multi-country retrospective cohort studyResearch in context |
| title_short | Sex differences in risk factors for unsuccessful tuberculosis treatment outcomes in Eastern Europe from 2020 to 2022: a multi-country retrospective cohort studyResearch in context |
| title_sort | sex differences in risk factors for unsuccessful tuberculosis treatment outcomes in eastern europe from 2020 to 2022 a multi country retrospective cohort studyresearch in context |
| topic | Tuberculosis Treatment outcome Sex Healthcare Socioeconomic factors Gender and health |
| url | http://www.sciencedirect.com/science/article/pii/S2666776225001462 |
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