How Endpoint Definitions Shape Epidemiologic Inference on Tuberculosis Treatment Outcomes: A Secondary Analysis from Lima, Peru.
- 1Facultad de Medicina (FAMED), Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas (UNTRM), Chachapoyas 01001, Amazonas, Peru.
Abstract
Background/objectives
Tuberculosis treatment outcomes are often dichotomized into heterogeneous composites that may obscure outcome-specific associations. We compared baseline characteristics across mutually exclusive out-comes-loss to follow-up (LTFU), death, and not evaluated/transferred versus documented cure-and examined the composite endpoints secondarily in a prospective cohort of adults with smear-positive pulmonary tuberculosis treated in Lima, Peru, in 2010-2011.Methods
The complete-case cohort included 1233 participants. The primary analysis used ridge-penalized multinomial logistic regression (lambda = 0.16); a mean bias-reduced multinomial model assessed sparse-data sensitivity.Results
Overall, 1016 participants were cured, 127 experienced LTFU, 30 died, and 60 were not evaluated/transferred. Drug use was associated primarily with LTFU (aOR 4.15; 95% CI 2.55-6.75), whereas HIV-positive status showed the largest, although imprecisely estimated, association with death (aOR 32.12; 95% CI 8.95-115.33; six deaths among 22 HIV-positive participants). The bias-reduced estimate was similar (aOR 35.56; 95% CI 9.80-129.08). Multidrug-resistant tuberculosis was associated with several non-cure categories; its association with the combined not evaluated/transferred category was largely driven by participants still in treatment at database closure. Composite endpoints changed the magnitude and interpretation of several associations and did not eliminate sparse outcome-exposure cells.Conclusions
Endpoint definitions therefore materially shaped epidemiologic inference. Dis-aggregated outcomes should be reported alongside composite indicators, and findings from this historical cohort should not be interpreted as contemporary risk estimates for Lima.
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BibTeX
@article{veraponce2026endpoint,
title = {{How Endpoint Definitions Shape Epidemiologic Inference on Tuberculosis Treatment Outcomes: A Secondary Analysis from Lima, Peru.}},
author = {Víctor Juan Vera-Ponce and Jhosmer Ballena-Caicedo and Namibia Jherly Cervera Vasquez and Marcos Daniel García-Rodríguez and Jorge Alejandro Yumpo Ynga and Fiorella E Zuzunaga-Montoya},
journal = {Infectious disease reports},
year = {2026},
month = sep,
doi = {10.3390/idr18050108},
url = {https://europepmc.org/article/MED/42930499},
note = {CC BY},
}
RIS
TY - JOUR
TI - How Endpoint Definitions Shape Epidemiologic Inference on Tuberculosis Treatment Outcomes: A Secondary Analysis from Lima, Peru.
AU - Víctor Juan Vera-Ponce
AU - Jhosmer Ballena-Caicedo
AU - Namibia Jherly Cervera Vasquez
AU - Marcos Daniel García-Rodríguez
AU - Jorge Alejandro Yumpo Ynga
AU - Fiorella E Zuzunaga-Montoya
PY - 2026
DA - 2026/09/26
JO - Infectious disease reports
DO - 10.3390/idr18050108
UR - https://europepmc.org/article/MED/42930499
AB - Background/objectives Tuberculosis treatment outcomes are often dichotomized into heterogeneous composites that may obscure outcome-specific associations. We compared baseline characteristics across mutually exclusive out-comes-loss to follow-up (LTFU), death, and not evaluated/transferred versus documented cure-and examined the composite endpoints secondarily in a prospective cohort of adults with smear-positive pulmonary tuberculosis treated in Lima, Peru, in 2010-2011.Methods The complete-case cohort included 1233 participants. The primary analysis used ridge-penalized multinomial logistic regression (lambda = 0.16); a mean bias-reduced multinomial model assessed sparse-data sensitivity.Results Overall, 1016 participants were cured, 127 experienced LTFU, 30 died, and 60 were not evaluated/transferred. Drug use was associated primarily with LTFU (aOR 4.15; 95% CI 2.55-6.75), whereas HIV-positive status showed the largest, although imprecisely estimated, association with death (aOR 32.12; 95% CI 8.95-115.33; six deaths among 22 HIV-positive participants). The bias-reduced estimate was similar (aOR 35.56; 95% CI 9.80-129.08). Multidrug-resistant tuberculosis was associated with several non-cure categories; its association with the combined not evaluated/transferred category was largely driven by participants still in treatment at database closure. Composite endpoints changed the magnitude and interpretation of several associations and did not eliminate sparse outcome-exposure cells.Conclusions Endpoint definitions therefore materially shaped epidemiologic inference. Dis-aggregated outcomes should be reported alongside composite indicators, and findings from this historical cohort should not be interpreted as contemporary risk estimates for Lima.
SN - 2036-7430
SN - 2036-7449
ER -