Disability Inequality in Short- and Long-Term Mortality After Multidrug-Resistant Tuberculosis
Abstract
Background: The impact of disability on mortality in multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) remains unclear despite the recognized vulnerability of individuals with disabilities.
Methods: We conducted a nationwide population-based retrospective cohort study using linked national databases. Individuals diagnosed with MDR/RR-TB between 2008 and 2019 were followed until death or December 2022. Short-term mortality was defined as death within two years after diagnosis, and long-term mortality was assessed among individuals who survived beyond two years using a landmark analysis. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for the associations between disability status and both short-term and long-term mortality.
Results: Among 11,292 individuals with MDR/RR-TB, 1,237 (11.0%) had registered disabilities. During the first two years after diagnosis, mortality was higher among individuals with disabilities than those without (15.8% vs. 5.9%, P < 0.001), corresponding to incidence rates of 87.0 and 30.5 per 1,000 person-years, respectively. Disability remained associated with increased short-term mortality after adjustment (aHR, 1.42; 95% CI, 1.20–1.67). Among individuals who survived at least two years, long-term mortality was also substantially higher in those with disabilities (40.2% vs. 17.0%, P < 0.001), with incidence rates of 56.0 and 19.9 per 1,000 person-years, respectively. Disability was strongly associated with long-term mortality (aHR, 2.81; 95% CI, 2.52–3.13), with higher risks observed across disability severity and specific disability types.
Conclusions: Disability is associated with significantly increased mortality during both treatment and post-treatment phases of MDR/RR-TB. These findings support disability-inclusive, patient-centred care across both treatment and post-treatment phases.
Key messages: • Disability was associated with substantially higher mortality among individuals with MDR/RR-TB, both within two years after diagnosis and among those who survived beyond two years.
• MDR/RR-TB care should incorporate disability status into risk assessment and extend beyond microbiological cure through long-term, patient-centred strategies for this vulnerable population.
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BibTeX
@article{park2026disability,
title = {{Disability Inequality in Short- and Long-Term Mortality After Multidrug-Resistant Tuberculosis}},
author = {JE Park and JS Min and SY Kim and JH Park},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1504},
url = {https://doi.org/10.1093/eurpub/ckag169.1504},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Disability Inequality in Short- and Long-Term Mortality After Multidrug-Resistant Tuberculosis
AU - JE Park
AU - JS Min
AU - SY Kim
AU - JH Park
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1504
UR - https://doi.org/10.1093/eurpub/ckag169.1504
AB - Background: The impact of disability on mortality in multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) remains unclear despite the recognized vulnerability of individuals with disabilities. Methods: We conducted a nationwide population-based retrospective cohort study using linked national databases. Individuals diagnosed with MDR/RR-TB between 2008 and 2019 were followed until death or December 2022. Short-term mortality was defined as death within two years after diagnosis, and long-term mortality was assessed among individuals who survived beyond two years using a landmark analysis. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for the associations between disability status and both short-term and long-term mortality. Results: Among 11,292 individuals with MDR/RR-TB, 1,237 (11.0%) had registered disabilities. During the first two years after diagnosis, mortality was higher among individuals with disabilities than those without (15.8% vs. 5.9%, P < 0.001), corresponding to incidence rates of 87.0 and 30.5 per 1,000 person-years, respectively. Disability remained associated with increased short-term mortality after adjustment (aHR, 1.42; 95% CI, 1.20–1.67). Among individuals who survived at least two years, long-term mortality was also substantially higher in those with disabilities (40.2% vs. 17.0%, P < 0.001), with incidence rates of 56.0 and 19.9 per 1,000 person-years, respectively. Disability was strongly associated with long-term mortality (aHR, 2.81; 95% CI, 2.52–3.13), with higher risks observed across disability severity and specific disability types. Conclusions: Disability is associated with significantly increased mortality during both treatment and post-treatment phases of MDR/RR-TB. These findings support disability-inclusive, patient-centred care across both treatment and post-treatment phases. Key messages: • Disability was associated with substantially higher mortality among individuals with MDR/RR-TB, both within two years after diagnosis and among those who survived beyond two years. • MDR/RR-TB care should incorporate disability status into risk assessment and extend beyond microbiological cure through long-term, patient-centred strategies for this vulnerable population.
SN - 1101-1262
SN - 1464-360X
ER -