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BACKGROUND: Although the incidence of tuberculosis is higher in men than in women, the relationship of sex with tuberculosis treatment outcomes has not been adequately studied. METHODS: We performed a retrospective cohort study and a systematic review and meta-analysis of observational studies during the last 10 years to assess sex differences in clinical and microbiological outcomes in tuberculosis. RESULTS: In our cohort of 2894 Taiwanese patients with drug-susceptible pulmonary tuberculosis (1975 male and 919 female), male patients had higher adjusted hazards of 9-month mortality due to all causes (hazard ratio, 1.43 95% confidence interval (CI), 1.03-1.98) and infections (1.70 1.09-2.64) and higher adjusted odds of 2-month sputum culture positivity (odds ratio OR, 1.56 95% CI, 1.05-2.33) compared with female patients. Smear positivity at 2 months did not differ significantly (OR, 1.27 95% CI, .71-2.27) between the sexes. Among 7896 articles retrieved, 398 were included in our systematic review describing a total of 3 957 216 patients. The odds of all-cause mortality were higher in men than in women in the pooled unadjusted (OR, 1.26 95% CI, 1.19-1.34) and adjusted (1.31 1.18-1.45) analyses. Men had higher pooled odds of sputum culture (OR, 1.44 95% CI, 1.14-1.81) and sputum smear (1.58 1.41-1.77) positivity, both at the end of the intensive phase and on completion of treatment. CONCLUSIONS: Our retrospective cohort showed that male patients with tuberculosis have higher 9-month all-cause and infection-related mortality, with higher 2-month sputum culture positivity after adjustment for confounding factors. In our meta-analysis, male patients showed higher all-cause and tuberculosis-related mortality and higher sputum culture and smear positivity rates during and after tuberculosis treatment.
Chidambaram et al. (Fri,) studied this question.