Mortality Risk Factors Among Indonesians with Tuberculosis: An Analysis of a National Health Insurance Data

Abstract

Tuberculosis (TB) significantly contributes to global mortality; thus, identifying mortality risks is crucial for effective disease management. This study aims to explore the risks of mortality among Indonesians with TB. This case-control study analyzed Indonesian health insurance data (2015-2022), employing propensity score matching (1:4 ratio) and Cox modeling to assess the relationship between mortality and demographics/comorbidities. Mortality was treated as a binary (death or survived) and a multistate outcome (including death within two months, death afterward, and survived). The analysis included 60,472 subjects and 1,777 deaths, revealing that most demographics had no correlation with mortality, except for marital status. Being married was protective against mortality after two months (Hazard Ratio [HR] 0.65, 95% Confidence Interval [CI]: 0.45-0.93). Anemia increased mortality risk over time (HR 3.62 within the first two months; 9.19 thereafter). Cancer and heart failure heightened mortality risk early on, while HIV affected later stages. Interestingly, some chronic conditions may provide protective effects. Access to healthcare through universal health coverage (UHC) may help reduce mortality risks. The study emphasizes critical management periods for TB in patients with specific conditions and highlights the importance of UHC in mitigating sociodemographic disparities to improve health outcomes.