Review of records of those died from tuberculosis concluded by the study for cause of death among Thai population in 2019

Abstract

Background: Thailand remains among the high tuberculosis (TB) burden countries. TB mortality rates are still inaccurate due to the incompleteness of the death certificates. The Cause of Death Study 2019 reported TB mortality considerably higher than estimates by the World Health Organization, raising concerns about the validity of assigning TB as the underlying cause of death.

Methods: This descriptive study reviewed the secondary data using death diagnostic forms from the Cause of Death Study 2019. Of 198 deaths initially identified as having TB as the underlying cause, 135 unique cases were included after removing duplicates. Two independent reviewers—a senior internist and a TB control expert—assessed each case using a five-level agreement scale regarding TB as the underlying cause of death. Inter-rater agreement was evaluated using weighted kappa statistics. Risks or conditions that led to death were enumerated and presented in percentages.

Results: Most decedents were male (74.8%) and aged over 60 years (54.8%). In the first review, the TB control expert was mostly uncertain whether TB was the underlying cause of death (69.6%), whereas the senior internist agreed or strongly agreed in 68.9% of cases. Inter-rater agreement was fair (weighted kappa = 0.226, p < 0.001). After the second review, concordance increased, with agreement in 77.0% of cases, including 89 cases in which both reviewers concluded TB as the underlying cause of death. Common risk factors or comorbidities included severe tuberculosis, alcohol use, diabetes mellitus, chronic lung diseases, and senility.

Conclusion & Recommendation: Determination of tuberculosis as the underlying cause of death varies by reviewer expertise and available clinical information, particularly among elderly patients with multiple comorbidities. Nevertheless, the findings underscore that severe tuberculosis remains a major issue in Thailand. Improving the quality of cause-of-death data and strengthening measures for prevention, diagnosis, and effective TB treatment are essential to reduce preventable deaths.