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.

中文翻译：

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结核病治疗开始时的粮食不安全与海地农村的临床结果相关：一项前瞻性队列研究


背景 结核病是全世界的主要死亡原因，众所周知，粮食不安全会通过多种途径对健康结果产生负面影响。很少有研究质疑粮食不安全与结核病结果之间的关系，特别是独立于营养的关系。方法 我们在海地的一个农村转诊中心对开始临床疑似或微生物学证实的药物敏感结核病一线治疗的成年人进行了一项前瞻性队列研究。我们进行了基线问卷调查，收集了临床数据，并分析了实验室样本。我们使用 logistic 回归模型来估计家庭粮食不安全 （家庭饥饿量表） 与治疗失败或死亡之间的关系。我们使用删失加权的逆概率考虑了失访患者的排除，并使用治疗加权的逆概率调整了测量的混杂因素和营养状况。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（四分位距）为 35 （25-45） 岁。其中，105 人 （41%） 家中没有饥饿，104 人 （40%） 家中有中度饥饿，48 人 （19%） 家中有严重饥饿。11 名参与者 （4%） 死亡，6 名 （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 在考虑失访、测量混杂因素和营养状况后，结核病治疗开始时的家庭粮食不安全与死亡或治疗失败显著相关。 除了已知的营养不良重要性外，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果。