Tuberculosis sanatorium treatment at the advent of the chemotherapy era
Abstract Background The discovery of antibiotics in the mid-twentieth century marked a major transition in tuberculosis (TB) treatment and control. There are few studies describing the duration of TB disease and its treatment from the pre-chemotherapy era and little data on how these treatments chan...
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crspringernat:10.1186/s12879-020-05539-w 2023-05-15T16:17:16+02:00 Tuberculosis sanatorium treatment at the advent of the chemotherapy era Zwick, Erin D. Pepperell, Caitlin S. National Institute of Allergy and Infectious Diseases National Institutes of Health 2020 http://dx.doi.org/10.1186/s12879-020-05539-w http://link.springer.com/content/pdf/10.1186/s12879-020-05539-w.pdf http://link.springer.com/article/10.1186/s12879-020-05539-w/fulltext.html en eng Springer Science and Business Media LLC http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/licenses/by/4.0/ CC-BY BMC Infectious Diseases volume 20, issue 1 ISSN 1471-2334 Infectious Diseases journal-article 2020 crspringernat https://doi.org/10.1186/s12879-020-05539-w 2022-01-04T16:28:16Z Abstract Background The discovery of antibiotics in the mid-twentieth century marked a major transition in tuberculosis (TB) treatment and control. There are few studies describing the duration of TB disease and its treatment from the pre-chemotherapy era and little data on how these treatments changed in response to the development of effective antibiotics. The goal of this research is to understand how inpatient treatment for high incidence populations, the First Nations peoples of Saskatchewan, Canada, changed in response to increasing availability of antibiotics effective against TB. We expected that as treatment regimens transitioned from convalescence-only to triple antibiotic therapy, the length of inpatient treatment would shorten. Methods Analyses were performed on records of sanatoria admissions and discharges occurring between 1933 and 1959 in Saskatchewan, Canada. Year of antibiotic discovery was taken as a proxy for treatment regimen: no chemotherapy (pre-1944), mono-therapy (Streptomycin, 1944–1946), dual-therapy (Streptomycin and PAS, 1946–1952), and triple-therapy (Streptomycin, PAS, and INH 1952-). A pooled linear regression of log-transformed length of first admission as predicted by year of admission was modeled to assess the relationship between admission length and year of admission, corrected for clinical and demographic variables. Results First admission length increased 19% in the triple-therapy era as compared to the pre-chemotherapy era, from 316 days (10.4 months) to 377 days (12.4 months). After the discovery of INH (1952), we find statistically significant increases in the proportion of successfully completed therapies (0.55 versus 0.60, p = 0.035), but also in patients who left hospital against medical advice (0.19 versus 0.29, p < 0.0001), indicating that as hospitalizations lengthened, more patients chose to discharge without the sanction of their physician. The readmission rate increased from 10 to 50% of all admissions while the province-level TB-specific death rate fell from 63.1 per 10,000 in 1933 to 4.7 per 10,000 in 1958. Conclusion Counterintuitively, we find that the length of first admissions increased with the discovery of TB-treating antibiotics. Increasing admission volume and readmission rate indicate an intensification of inpatient TB treatment during this era. These analyses provide a novel estimate of the effect of changing treatment policy on sanatorium admissions in this population. Article in Journal/Newspaper First Nations Springer Nature (via Crossref) Canada BMC Infectious Diseases 20 1 |
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Open Polar |
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Springer Nature (via Crossref) |
op_collection_id |
crspringernat |
language |
English |
topic |
Infectious Diseases |
spellingShingle |
Infectious Diseases Zwick, Erin D. Pepperell, Caitlin S. Tuberculosis sanatorium treatment at the advent of the chemotherapy era |
topic_facet |
Infectious Diseases |
description |
Abstract Background The discovery of antibiotics in the mid-twentieth century marked a major transition in tuberculosis (TB) treatment and control. There are few studies describing the duration of TB disease and its treatment from the pre-chemotherapy era and little data on how these treatments changed in response to the development of effective antibiotics. The goal of this research is to understand how inpatient treatment for high incidence populations, the First Nations peoples of Saskatchewan, Canada, changed in response to increasing availability of antibiotics effective against TB. We expected that as treatment regimens transitioned from convalescence-only to triple antibiotic therapy, the length of inpatient treatment would shorten. Methods Analyses were performed on records of sanatoria admissions and discharges occurring between 1933 and 1959 in Saskatchewan, Canada. Year of antibiotic discovery was taken as a proxy for treatment regimen: no chemotherapy (pre-1944), mono-therapy (Streptomycin, 1944–1946), dual-therapy (Streptomycin and PAS, 1946–1952), and triple-therapy (Streptomycin, PAS, and INH 1952-). A pooled linear regression of log-transformed length of first admission as predicted by year of admission was modeled to assess the relationship between admission length and year of admission, corrected for clinical and demographic variables. Results First admission length increased 19% in the triple-therapy era as compared to the pre-chemotherapy era, from 316 days (10.4 months) to 377 days (12.4 months). After the discovery of INH (1952), we find statistically significant increases in the proportion of successfully completed therapies (0.55 versus 0.60, p = 0.035), but also in patients who left hospital against medical advice (0.19 versus 0.29, p < 0.0001), indicating that as hospitalizations lengthened, more patients chose to discharge without the sanction of their physician. The readmission rate increased from 10 to 50% of all admissions while the province-level TB-specific death rate fell from 63.1 per 10,000 in 1933 to 4.7 per 10,000 in 1958. Conclusion Counterintuitively, we find that the length of first admissions increased with the discovery of TB-treating antibiotics. Increasing admission volume and readmission rate indicate an intensification of inpatient TB treatment during this era. These analyses provide a novel estimate of the effect of changing treatment policy on sanatorium admissions in this population. |
author2 |
National Institute of Allergy and Infectious Diseases National Institutes of Health |
format |
Article in Journal/Newspaper |
author |
Zwick, Erin D. Pepperell, Caitlin S. |
author_facet |
Zwick, Erin D. Pepperell, Caitlin S. |
author_sort |
Zwick, Erin D. |
title |
Tuberculosis sanatorium treatment at the advent of the chemotherapy era |
title_short |
Tuberculosis sanatorium treatment at the advent of the chemotherapy era |
title_full |
Tuberculosis sanatorium treatment at the advent of the chemotherapy era |
title_fullStr |
Tuberculosis sanatorium treatment at the advent of the chemotherapy era |
title_full_unstemmed |
Tuberculosis sanatorium treatment at the advent of the chemotherapy era |
title_sort |
tuberculosis sanatorium treatment at the advent of the chemotherapy era |
publisher |
Springer Science and Business Media LLC |
publishDate |
2020 |
url |
http://dx.doi.org/10.1186/s12879-020-05539-w http://link.springer.com/content/pdf/10.1186/s12879-020-05539-w.pdf http://link.springer.com/article/10.1186/s12879-020-05539-w/fulltext.html |
geographic |
Canada |
geographic_facet |
Canada |
genre |
First Nations |
genre_facet |
First Nations |
op_source |
BMC Infectious Diseases volume 20, issue 1 ISSN 1471-2334 |
op_rights |
http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/licenses/by/4.0/ |
op_rightsnorm |
CC-BY |
op_doi |
https://doi.org/10.1186/s12879-020-05539-w |
container_title |
BMC Infectious Diseases |
container_volume |
20 |
container_issue |
1 |
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1766003111680278528 |