Current Respiratory Medicine Reviews   Send Orders for Reprints to reprints@benthamscience.net Current Respiratory Medicine Reviews, 2019, 15, 21-25 21 RESEARCH ARTICLE Social Determinants Associated with Tuberculosis Mortality in a General Hospital in Mexico Juan Ángel Ábrego-Fernández 1 and Rafael Laniado-Laborín 1,2,3,* 1 Clínica y Laboratorio de Tuberculosis, Hospital General Tijuana, Tijuana, Mexico; 2 Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Maxicali, Mexico; 3 SNI II, Sistema Nacional de Investigadores, Conacyt, Mexico City, Mexico Abstract: Background: Most TB deaths can be prevented with timely diagnosis and appropriate treatment. In fact, millions of people are diagnosed and treated successfully every year, avoiding millions of deaths. However, globally, there are still huge gaps in detection and treatment. Objective: To identify the social determinants associated with mortality due to TB in a general hospital in Mexico. Methodology: All patients admitted with a diagnosis of pulmonary tuberculosis to the Emergency Department of a hospital in Mexico were included during a 10-month period. At the end of the study, the condition of discharge of all cases was obtained from the electronic database of the State Tuberculosis Program. Results: One-hundred and twenty-four patients with tuberculosis were included in the sample. Thirty-eight patients (30.6%) died during their hospital stay and eleven (8.9%) died outside the hospital after their discharge, for a total of 49 (39.5%) deaths. Of the 29 patients with HIV/AIDS, 12 died (41.3%). Logistic regression analysis showed that older age, imprisonment, and previous tuberculosis were significant predictors of mortality. Conclusion: The mortality of tuberculosis patients diagnosed in HGT is very high, mainly because the diagnosis is established at the hospital level, which implies a late diagnosis. A R T I C L E H I S T O R Y Received: November 09, 2018 Revised: January 17, 2019 Accepted: January 19, 2019 DOI: 10.2174/1573398X15666190119160031 Keywords: Antituberculosis drugs, HIV, imprisonment, mortality, social determinants, tuberculosis. 1. INTRODUCTION Historically, tuberculosis (TB) is known as a social problem with medical repercussions; it is a well-established fact that the disease prevalence decreases drastically in a way inversely proportional to sociodemographic progress [1]. Most TB deaths can be prevented with timely diagnosis and appropriate treatment. In fact, millions of people are diagnosed and treated successfully every year, avoiding millions of deaths (approximately 53 million deaths prevented during the period 2000-2016), but there are still huge gaps in detection and treatment. Worldwide, the death rate from tuberculosis decreased by 37% between the year 2000 (1.7 million deaths) and the year 2016 (1.3 million) [2]. The state of Baja California reports the highest incidence rate (58.4 per 10 5 in 2017) and mortality (7.61 per 10 5 in 2016) in Mexico, rates that triple and quadruple respectively the national rates of TB incidence and mortality. The city of Tijuana in Baja California reports annually the highest proportion of TB cases diagnosed in the state [3]. *Address correspondence to this author at the Clínica y Laboratorio de Tuberculosis, Hospital General Tijuana, Tijuana, Mexico; Tel: (664) 368-7041; E-mail: rlaniado@uabc.edu.mx The objective of the study was to identify the social determinants and other risk factors associated with this high TB mortality rate. 2. MATERIALS AND METHODS The city of Tijuana is in the extreme northwest of the country, on the border with the United States of America (USA). In 2015, the national census reported a population of 1.6 million inhabitants in the city [4]. Its border with the USA is the busiest in the world with more than 40 million border crossings annually with an intense national and international immigration. All patients admitted to the Emergency Service of the Tijuana General Hospital with the diagnosis of pulmonary tuberculosis during the period from September 1, 2017, to June 30, 2018, were prospectively recruited. Initial screening of all subjects with suspected TBP, was carried out with a standardized questionnaire to obtain demographic and clinical information; sputum samples were obtained (spontaneous or induced) in all TB suspects for microscopy, culture and drug-susceptibility testing for first- line antituberculosis drugs (BACTEC ® MGIT 960) and 1875-6387/19 $58.00+.00 © 2019 Bentham Science Publishers