Survival and factors associated with mortality among people with tuberculosis in Medellín, Colombia (2018-2023): a retrospective cohort study.
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OBJECTIVE: To determine the survival rate and prognostic factors associated with tuberculosis (TB) mortality in Medellín between 2018 and 2023. DESIGN: Quantitative observational analytical study of a retrospective cohort. SETTING: Based on notifications made to the Public Health Surveillance System and managed by the Secretary of Health of Medellín-Colombia between 2018 and 2023. PARTICIPANTS: A total of 11 202 individuals diagnosed with TB, aged between 1 and 103 years. PRIMARY AND SECONDARY OUTCOME MEASURES: The Kaplan-Meier method was employed to determine survival and risk functions, as well as median survival. Crude HRs and adjusted HRs (aHRs) were estimated using Cox proportional hazards regression models. RESULTS: A median overall survival of 1410 days (3.86 years) and an adjusted mortality rate of 40 cases per 100 000 population were estimated for the study period (6 years). Factors associated with TB mortality were age (>59 years) (aHR 5.53; 95% CI 3.17 to 9.65), renal disease (aHR 2.98; 95% CI 2.27 to 3.90), HIV infection (aHR 2.82; 95% CI 1.39 to 3.32) and cancer (aHR 2.56; 95% CI 1.95 to 3.34). CONCLUSIONS: TB survival is influenced by age and comorbidities, indicating the need for targeted strategies to protect high-risk groups. Strengthening comprehensive TB control through timely diagnosis, integrated management of chronic conditions and patient-centred care is essential to reduce preventable deaths. Furthermore, improving case notification and follow-up through integrated information platforms will contribute to more effective public health interventions.