Background Improved understanding of the epidemiology and mortality risk factors of extrapulmonary tuberculosis (EPTB) may facilitate successful diagnosis and management. Methods We analyzed national surveillance data from Ukraine to characterize EPTB subtypes (ie, localized in different anatomic sites). We calculated annual reported incidence, stratified by age, sex, and human immunodeficiency virus (HIV) status. Using Cox regression, we estimated mortality risk factors. Results Between January 2015 and November 2018, 14 062 adults/adolescents (≥15 years) and 417 children (<15 years) had EPTB with or without concomitant pulmonary TB. The most commonly reported EPTB subtypes were pleural, peripheral lymph node, and osteoarticular. Most EPTB subtype notifications peaked at age 30–39 years and were higher in males. In adults/adolescents, most peripheral TB lymphadenitis, central nervous system (CNS) TB, and abdominal TB occurred in those with untreated HIV. CNS TB notifications in people without HIV peaked before age 5 years. Adults/adolescents with CNS TB (adjusted hazard ratio [aHR]: 3.22; 95% CI: 2.89–3.60) and abdominal TB (aHR: 1.83; 95% CI: 1.59–2.11) were more likely to die than those with pulmonary TB. Children with CNS TB were more likely to die (aHR: 88.25; 95% CI: 43.49–179.10) than those with non-CNS TB. Among adults/adolescents, older age and HIV were associated with death. Rifampicin resistance was associated with mortality in pleural, peripheral lymph node, and CNS TB. Conclusions We identified the most common EPTB subtypes by age and sex, patterns of EPTB disease by HIV status, and mortality risk factors. These findings can inform diagnosis and care for people with EPTB.

中文翻译：

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乌克兰肺外结核病的发病率和死亡率：国家监测数据分析

背景 提高对肺外结核 (EPTB) 流行病学和死亡风险因素的了解可能有助于成功诊断和管理。方法 我们分析了乌克兰的国家监测数据，以描述 EPTB 亚型（即位于不同解剖部位）的特征。我们计算了年度报告的发病率，按年龄、性别和人类免疫缺陷病毒 (HIV) 状况分层。使用 Cox 回归，我们估计了死亡风险因素。结果 2015年1月至2018年11月期间，14 062名成人/青少年（≥15岁）和417名儿童（<15岁）患有EPTB，伴或不伴有肺结核。最常见的 EPTB 亚型是胸膜、周围淋巴结和骨关节。大多数 EPTB 亚型通知在 30-39 岁之间达到顶峰，并且男性中更高。在成人/青少年中，大多数外周结核性淋巴结炎、中枢神经系统 (CNS) 结核和腹部结核发生在未经治疗的艾滋病毒感染者中。未感染艾滋病毒的人群中的中枢神经系统结核病报告在 5 岁之前达到顶峰。患有中枢神经系统结核（调整后风险比 [aHR]：3.22；95% CI：2.89–3.60）和腹部结核（aHR：1.83；95% CI：1.59–2.11）的成人/青少年比肺结核患者更有可能死亡。患有中枢神经系统结核的儿童比患有非中枢神经系统结核的儿童更有可能死亡（aHR：88.25；95% CI：43.49–179.10）。在成人/青少年中，年龄较大和艾滋病毒与死亡相关。利福平耐药与胸膜、外周淋巴结和中枢神经系统结核的死亡率相关。结论 我们按年龄和性别、按 HIV 状况划分的 EPTB 疾病模式以及死亡风险因素确定了最常见的 EPTB 亚型。这些发现可以为 EPTB 患者的诊断和护理提供信息。