Sex differences in risk factors for unsuccessful tuberculosis treatment outcomes in Eastern Europe from 2020 to 2022: a multi-country retrospective cohort study
Skouvig Pedersen O. Butova T. Miasoiedov V. Feshchenko Y. Kuzhko M. Niemann S. Rosenthal A. Grinev A. Rosenfeld G. Hoppes M.D. Kilmnick J. Crudu V. Ciobanu N. Codreanu A. Toxanbayeva B. Chingissova L. Yurko K. Kucheriavchenko V. Vekshyn V. Vashakidze S. Shubladze N. Avaliani Z. Kadyrov A. Kalmambetova G. Sydykova M. Ghita E. Grecu V.I. Miulescu A.M. Wejse C.M. Fløe A. Dahl V.N. Butov D.
August 2025Elsevier Ltd
The Lancet Regional Health - Europe
2025#55
Background: Addressing the disproportionate representation between sexes is essential for achieving universal health coverage. Studies on the association between sex and unsuccessful tuberculosis treatment outcomes have shown conflicting results. This study examines this association and analyses sex-stratified risk factors associated with unsuccessful outcomes. Methods: This retrospective, observational cohort study analysed prospectively collected data from six Eastern European countries from 2020 to 2022. Treatment outcomes were defined using World Health Organization criteria. Uni- and multivariable logistic regression models were used to assess the association between sex and unsuccessful outcomes (‘treatment failure’, ‘lost to follow-up’, ‘died’, or any of these). After propensity score matching females and males, the multivariable analysis was repeated. Risk factors were analysed separately for each sex and compared using interaction terms. Findings: Among females, 19·5% (n = 290/1490) (95% confidence interval [CI]: 18, 22) achieved an unsuccessful treatment outcome, compared with 30% (n = 1363/4553) (95% CI: 29, 31) among males. In the multivariable analyses, female sex was associated with 32% lower odds of any unsuccessful outcome (adjusted odds ratio [aOR] 0·68, 95% CI: 0·58, 0·80), 36% lower odds of dying (aOR 0·64, 95% CI: 0·51, 0·80), and 37% lower odds of treatment failure (aOR 0·63, 95% CI: 0·47, 0·85). The association between sex and being ‘lost to follow-up’ was not significant. In the propensity score-matched cohort, sex was not associated with unsuccessful outcomes. Risk factors for unsuccessful outcomes were similar for females and males, except that in females aged >65 years, the odds of death were 2·2 times higher (95% CI: 1·1, 4·4). Interpretation: Male sex was associated with unsuccessful outcomes, including death and treatment failure, but adjusting for socio-demographic and clinical factors, and matching males to females, attenuated the association, suggesting that sex disparities in tuberculosis outcomes may be driven more by behavioural than biological factors. Longitudinal studies are needed to confirm these findings. Funding: The publication fee was funded by the Civilian Research and Development Foundation (CRDF) under grant #G-202407-72538.
Gender and health , Healthcare , Sex , Socioeconomic factors , Treatment outcome , Tuberculosis
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Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
Outpatient Department, Merefa Central District Hospital, Merefa, Ukraine
Kharkiv National Medical University, Kharkiv, Ukraine
National Scientific Center of Phthisiatry, Pulmonology and Allergology named after F. G. Yanovskyi, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
Molecular and Experimental Mycobacteriology Group, Research Center Borstel, Borstel, Germany
German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany
EPHE, PSL, University, Paris, France
Institut de Systématique, Évolution, Biodiversité (ISYEB), Muséum national dHistoire naturelle, CNRS, Sorbonne Université, EPHE, Université des Antilles, Paris, France
Office of Cyber Infrastructure and Computational Biology, U.S. National Institute of Allergy and Infectious Diseases, Rockville, MD, United States
National TB Reference Laboratory, Institute of Phthisiopneumology, Chisinau, Moldova
National Reference Laboratory, National Scientific Center of Phthisiopulmonology, Almaty, Kazakhstan
National Center for TB and Lung Diseases, Tbilisi, Georgia
The University of Georgia, Tbilisi, Georgia
European University, Tbilisi, Georgia
National Tuberculosis Center, Bishkek, Kyrgyzstan
Spirans Association, Bucharest, Romania
TB Ambulatory, Victor Babes Clinical Hospital for Infectious Disease and Pneumophthisiology, Craiova, Romania
IIIrd Pneumo-Phthisiology Ward, Leamna Phthisiology Hospital, Bucovat, Romania
Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
Department of Respiratory Diseases and Allergy
Outpatient Department
Kharkiv National Medical University
National Scientific Center of Phthisiatry
Molecular and Experimental Mycobacteriology Group
German Center for Infection Research (DZIF)
EPHE
Institut de Systématique
Office of Cyber Infrastructure and Computational Biology
National TB Reference Laboratory
National Reference Laboratory
National Center for TB and Lung Diseases
The University of Georgia
European University
National Tuberculosis Center
Spirans Association
TB Ambulatory
IIIrd Pneumo-Phthisiology Ward
Department of Infectious Diseases
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