When hospital admission source was added to the multivariate model, the associations with patient characteristics and mortality were not significantly changed. However, patients admitted to the hospital through the emergency department were more than twice as likely to die during their hospitalization compared to those with routine hospital admissions (OR, 2.38; p = 0.001). Hospital characteristics were not significant in multivariate analysis and, when included in the multivariate model, did not significantly change the results (data not shown).
This is the largest study, to date, to provide nationally representative estimates of outcomes of hospitalized patients with TB in the United States. Since the observations in this study are not limited to specific geographic areas or subgroups of patients, the external validity of these results is increased. Using a national database, we identified patients hospitalized with TB in the United States in 2000 along with predictors of in-hospital mortality. There were 2,279 TB hospitalizations in our sample, representing 20% of US hospitalizations. Extrapolating from this finding (using hospital discharge weights), we estimate that there were > 11,000 TB hospital admissions in the United States in 2000. Although one patient may be hospitalized more than once, there were only 16,377 TB cases reported to the Centers for Disease Control and Prevention in 2000. Thus, it is likely that a high proportion of people with TB are being hospitalized, and they experience a high in-hospital mortality rate of 4.9%. In addition, based on these findings in 2000, there were > 160,000 hospital days and > $385 million in hospital charges estimated for TB patients. These observations are intriguing, for while TB is often considered a vanishing disease in the United States, there is still a substantial burden on the US health system.