Cumulative incidence and factors associated with unfavorable tuberculosis treatment outcomes among people living with HIV in Liangshan, China: a competing-risk analysis
- 1Sichuan Center for Disease Control and Prevention
Abstract
Background: Cure or treatment completion precludes a later unfavorable tuberculosis (TB) treatment outcome within the same treatment episode and should be treated as a competing event. We estimated the cumulative incidence and exploratory associated factors for unfavorable outcomes among people with HIV-associated TB in Liangshan, China.
Methods: Aalen–Johansen cumulative incidence functions and Fine–Gray subdistribution hazard models were used. The 14-parameter full model was treated as exploratory; a prespecified three-parameter Fine–Gray sensitivity model, a cause-specific hazards model, and a proportionality assessment were included. Pointwise 95% confidence intervals for the cumulative incidence functions were obtained using 2,000 individual-level bootstrap resamples.
Results: Among 340 closed treatment episodes, 27 unfavorable outcomes, 303 cure/completion events, and 10 administrative censorings were observed. The unfavorable cumulative incidence was 4.41% (95% CI 2.35–6.77) at 3 months, 6.47% (3.82–9. 12) at 6 months, 7.65% (5.00–10.60) at 9 months, and 7.96% (5.30–10.91) at 12 months. Twenty-two of 27 unfavorable outcomes (81.5%) were records coded as non-TB death; the source field contained no separate TB-related-death category. In the full exploratory model, age was associated with the outcome (adjusted sHR 1.54 per 10 years, 95% CI 1.02–2.32; p = 0.039). In the parsimonious model, age (sHR 1.70, 95% CI 1.18–2.43; p = 0.004) and tracing versus all other sources (sHR 4.73, 95% CI 1.89–11.86; p = 0.001) showed elevated estimates, while inference remained exploratory.
Conclusion: The 12-month unfavorable cumulative incidence was 7.96% (95% CI 5.30–10.91), with only 33 individuals at risk at that landmark. The mortality-dominated composite and sparse categories limit interpretation; the findings describe exploratory associations rather than a validated prediction model.
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BibTeX
@article{yang2026cumulative,
title = {{Cumulative incidence and factors associated with unfavorable tuberculosis treatment outcomes among people living with HIV in Liangshan, China: a competing-risk analysis}},
author = {Ni Yang and Ting Li and Yunkui Li and Lan Xia},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1958022},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1958022/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Cumulative incidence and factors associated with unfavorable tuberculosis treatment outcomes among people living with HIV in Liangshan, China: a competing-risk analysis
AU - Ni Yang
AU - Ting Li
AU - Yunkui Li
AU - Lan Xia
PY - 2026
DA - 2026/10/21
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1958022
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1958022/full
AB - Background: Cure or treatment completion precludes a later unfavorable tuberculosis (TB) treatment outcome within the same treatment episode and should be treated as a competing event. We estimated the cumulative incidence and exploratory associated factors for unfavorable outcomes among people with HIV-associated TB in Liangshan, China. Methods: Aalen–Johansen cumulative incidence functions and Fine–Gray subdistribution hazard models were used. The 14-parameter full model was treated as exploratory; a prespecified three-parameter Fine–Gray sensitivity model, a cause-specific hazards model, and a proportionality assessment were included. Pointwise 95% confidence intervals for the cumulative incidence functions were obtained using 2,000 individual-level bootstrap resamples. Results: Among 340 closed treatment episodes, 27 unfavorable outcomes, 303 cure/completion events, and 10 administrative censorings were observed. The unfavorable cumulative incidence was 4.41% (95% CI 2.35–6.77) at 3 months, 6.47% (3.82–9. 12) at 6 months, 7.65% (5.00–10.60) at 9 months, and 7.96% (5.30–10.91) at 12 months. Twenty-two of 27 unfavorable outcomes (81.5%) were records coded as non-TB death; the source field contained no separate TB-related-death category. In the full exploratory model, age was associated with the outcome (adjusted sHR 1.54 per 10 years, 95% CI 1.02–2.32; p = 0.039). In the parsimonious model, age (sHR 1.70, 95% CI 1.18–2.43; p = 0.004) and tracing versus all other sources (sHR 4.73, 95% CI 1.89–11.86; p = 0.001) showed elevated estimates, while inference remained exploratory. Conclusion: The 12-month unfavorable cumulative incidence was 7.96% (95% CI 5.30–10.91), with only 33 individuals at risk at that landmark. The mortality-dominated composite and sparse categories limit interpretation; the findings describe exploratory associations rather than a validated prediction model.
SN - 2296-2565
ER -