Abstract：
BACKGROUND: Tuberculosis is a leading cause of death worldwide, and food insecurity is known to negatively influence health outcomes through multiple pathways. Few studies have interrogated the relationship between food insecurity and tuberculosis outcomes, particularly independent of nutrition.
METHODS: We conducted a prospective cohort study of adults initiating first-line treatment for clinically suspected or microbiologically confirmed drug-sensitive tuberculosis at a rural referral center in Haiti. We administered a baseline questionnaire, collected clinical data, and analyzed laboratory samples. We used logistic regression models to estimate the relationship between household food insecurity (Household Hunger Scale) and treatment failure or death. We accounted for exclusion of patients lost to follow-up using inverse probability of censoring weighting and adjusted for measured confounders and nutritional status using inverse probability of treatment weighting.
RESULTS: We enrolled 257 participants (37% female) between May 2020 and March 2023 with a median age (interquartile range) of 35 (25-45) years. Of these, 105 (41%) had no hunger in the household, 104 (40%) had moderate hunger in the household, and 48 (19%) had severe hunger in the household. Eleven participants (4%) died, and 6 (3%) had treatment failure. After adjustment, food insecurity was significantly associated with subsequent treatment failure or death (odds ratio 5.78 [95% confidence interval, 1.20-27.8]; P = .03).
CONCLUSIONS: Household food insecurity at tuberculosis treatment initiation was significantly associated with death or treatment failure after accounting for loss to follow-up, measured confounders, and nutritional status. In addition to the known importance of undernutrition, our findings indicate that food insecurity independently affects tuberculosis treatment outcomes in Haiti.
METHODS: We conducted a prospective cohort study of adults initiating first-line treatment for clinically suspected or microbiologically confirmed drug-sensitive tuberculosis at a rural referral center in Haiti. We administered a baseline questionnaire, collected clinical data, and analyzed laboratory samples. We used logistic regression models to estimate the relationship between household food insecurity (Household Hunger Scale) and treatment failure or death. We accounted for exclusion of patients lost to follow-up using inverse probability of censoring weighting and adjusted for measured confounders and nutritional status using inverse probability of treatment weighting.
RESULTS: We enrolled 257 participants (37% female) between May 2020 and March 2023 with a median age (interquartile range) of 35 (25-45) years. Of these, 105 (41%) had no hunger in the household, 104 (40%) had moderate hunger in the household, and 48 (19%) had severe hunger in the household. Eleven participants (4%) died, and 6 (3%) had treatment failure. After adjustment, food insecurity was significantly associated with subsequent treatment failure or death (odds ratio 5.78 [95% confidence interval, 1.20-27.8]; P = .03).
CONCLUSIONS: Household food insecurity at tuberculosis treatment initiation was significantly associated with death or treatment failure after accounting for loss to follow-up, measured confounders, and nutritional status. In addition to the known importance of undernutrition, our findings indicate that food insecurity independently affects tuberculosis treatment outcomes in Haiti.
摘要：
背景：结核病是全球范围内的主要死亡原因，众所周知，粮食不安全通过多种途径对健康结果产生负面影响。很少有研究询问粮食不安全与结核病结局之间的关系。尤其是独立于营养。
方法：我们进行了一项前瞻性队列研究，研究对象是在海地农村转诊中心开始临床疑似或微生物学证实的药物敏感性结核病一线治疗的成人。我们进行了基线调查问卷，收集临床数据，并分析了实验室样本。我们使用逻辑回归模型来估计家庭食物不安全（家庭饥饿量表）与治疗失败或死亡之间的关系。我们使用检查权重的逆概率解释了排除随访失败的患者，并使用治疗权重的逆概率对测量的混杂因素和营养状况进行了调整。
结果：我们在2020年5月至2023年3月期间招募了257名参与者（37％为女性），中位年龄（四分位数范围）为35（25-45）岁。其中,105（41％）的家庭没有饥饿，104(40%)家庭有中度饥饿，和48（19％）的家庭有严重的饥饿。11名参与者（4%）死亡，6例(3%)治疗失败。调整后,粮食不安全与随后的治疗失败或死亡显著相关(比值比5.78[95%置信区间，1.20-27.8]；P=.03）。
结论：在考虑到失去随访后，结核病治疗开始时的家庭食物不安全与死亡或治疗失败显著相关。测量的混杂因素，和营养状况。除了众所周知的营养不良的重要性，我们的研究结果表明,粮食不安全独立影响海地的结核病治疗结局.
方法：我们进行了一项前瞻性队列研究，研究对象是在海地农村转诊中心开始临床疑似或微生物学证实的药物敏感性结核病一线治疗的成人。我们进行了基线调查问卷，收集临床数据，并分析了实验室样本。我们使用逻辑回归模型来估计家庭食物不安全（家庭饥饿量表）与治疗失败或死亡之间的关系。我们使用检查权重的逆概率解释了排除随访失败的患者，并使用治疗权重的逆概率对测量的混杂因素和营养状况进行了调整。
结果：我们在2020年5月至2023年3月期间招募了257名参与者（37％为女性），中位年龄（四分位数范围）为35（25-45）岁。其中,105（41％）的家庭没有饥饿，104(40%)家庭有中度饥饿，和48（19％）的家庭有严重的饥饿。11名参与者（4%）死亡，6例(3%)治疗失败。调整后,粮食不安全与随后的治疗失败或死亡显著相关(比值比5.78[95%置信区间，1.20-27.8]；P=.03）。
结论：在考虑到失去随访后，结核病治疗开始时的家庭食物不安全与死亡或治疗失败显著相关。测量的混杂因素，和营养状况。除了众所周知的营养不良的重要性，我们的研究结果表明,粮食不安全独立影响海地的结核病治疗结局.
