Factors Associated with Unfavourable Treatment Outcomes in Patients with Tuberculosis: A 16-Year Cohort Study (2005–2020), Republic of Karakalpakstan, Uzbekistan

Tuberculosis (TB) remains a public health burden in the Republic of Karakalpakstan, Uzbekistan. This region-wide retrospective cohort study reports the treatment outcomes of patients registered in the TB electronic register and treated with first-line drugs in the TB Programme of the Republic of Karakalpakstan from 2005–2020 and factors associated with unfavourable outcomes. Among 35,122 registered patients, 24,394 (69%) patients were adults, 2339 (7%) were children, 18,032 (51%) were male and 19,774 (68%) lived in rural areas. Of these patients, 29,130 (83%) had pulmonary TB and 7497 (>22%) had been previously treated. There were 7440 (21%) patients who had unfavourable treatment outcomes. Factors associated with unfavourable treatment outcomes included: increasing age, living in certain parts of the republic, disability, pensioner status, unemployment, being HIV-positive, having pulmonary TB, and receiving category II treatment. Factors associated with death included: being adult and elderly, living in certain parts of the republic, having a disability, pensioner status, being HIV-positive, and receiving category II treatment. Factors associated with failure included: being adolescent, female, having pulmonary TB. Factors associated with loss to follow-up included: being male, disability, pensioner status, unemployment, receiving category II treatment. In summary, there are sub-groups of patients who need special attention in order to decrease unfavourable treatment outcomes.

Sickness Absence and Disability Pension in the Very Long Term: A Finnish Register-Based Study With 20 Years Follow-Up

Sickness allowance is paid for short-term sickness absence and is thus an indicator of temporary ill health, but it is also associated with a heightened risk of receiving disability pension. Using event history analysis, we examined the long-term risk for disability pension receipt after first observed receipt of medically certified sickness allowance in each single year after sickness allowance was first recorded. Utilizing longitudinal data from the Finnish population register, covering the period 1989–2010, we observed 110,675 individuals aged 16–40 years at baseline. Using discrete-time hazard models, we estimated how the first observed receipt of sickness allowance was related to the risk of receiving disability pension, with an average follow-up time of 20.6 years. In this population, about 40 percent received sickness allowance and 10 percent received disability pension. In the first years after sickness allowance receipt, there was a substantial difference between long-term and short-term sickness allowance recipients in the hazard of becoming a disability pensioner. This difference levelled out over time, but even 20 years after the first observed sickness allowance receipt, the hazard of disability retirement was more than 15 times higher than that of non-recipients of sickness allowance. Patterns were similar for men and women. First observed receipt of sickness allowance is a powerful predictor for disability pension receipt, also in the very distant future. Thus, it can be used to monitor people with heightened risk of becoming more permanently ill and falling outside the labour market.

Disability retirement and all-cause mortality in ages 65–70: A comparison of Finnish speakers and Swedish speakers in Finland

Swedish speakers in Finland have higher life expectancy and lower disability retirement rates than Finnish speakers. Although disability retirement is an important mortality predictor, no previous study has analysed the ethnolinguistic mortality gradient in light of the difference in disability pension receipt. We study how being a disability pensioner in ages 50–64 relates to mortality in ages 65–70 and whether the two ethnolinguistic groups differ in this respect. We use Cox regressions on longitudinal population register data covering 1987–2011. Disability pensioners have a mortality hazard that is about twice that of employed persons. We find this pattern to be highly similar for both ethnolinguistic groups. Our results highlight that in order to understand mortality variation across population subgroups, adequate control for previous labour market position is needed. The Finnish welfare system seems to respond appropriately in identifying disability pensioners with equally impaired health in both ethnolinguistic groups.