(P-628) Impact of Multimorbidity Subgroups on the Health Care Use, Expenditures, and Clinical Outcomes Among Patients with Tuberculosis: A Population-based Cohort Analysis

Background: Although most patients with tuberculosis (TB) achieve favorable treatment outcomes, there are higher risks of co-existing multimorbidity among an increasingly elderly population. The types and combinations of such conditions are not described.

Objectives: To assess multimorbidity subgroups on the health care use, expenditures, and clinical outcomes among patients with tuberculosis in real-world settings.

Methods: 1. Setting
Population-based retrospective cohort study of patients receiving first-line anti-TB drugs in the Chinese Center for Disease Control and Prevention TB registry linked to Ningbo Regional Health Care Database (NRHCD) between 2015 and 2020.
2. Exposures
Latent class membership on comorbidity groups identified using latent class analysis among patients with at least 1 condition in addition to tuberculosis.
3. Main outcome measures
Clinical outcomes of TB treatment, health care use, and expenditures.
4. Statistical analysis
Eligible patients were followed until the end of TB treatment, end of enrollment, death or end of study period (June 30, 2020). Multivariable logistic regression models and 2-part regression models were constructed to retrospectively assess association of latent class membership with clinical outcomes and healthcare expenditures, respectively.

Results: We identified a cohort of 9,651 adult patients with TB, of whom approximately 38.6% had at least 1 chronic condition in addition to TB. We identified four chronic condition subgroups, 1) Respiratory morbidity (220, 5.9%), 2) Cardiovascular morbidity with complications (185,5.0%), 3) Cardiovascular morbidity without complications (1292,34.7%), 4) General morbidity (2030,54.5%). The treatment success odds were statistically lower in the respiratory morbidity (OR, 0.68) and cardiovascular morbidity with complications group (OR, 0.59), while higher in the cardiovascular morbidity without complications (OR, 1.40), while compared to patients with no chronic conditions. After Adjusting for age groups, sex, type of health insurance, tuberculosis retreatment status, smoking, alcohol consumption patterns, and number of hospital admissions at baseline, the respiratory morbidity group had CNY ￥16,360 [95%CI, 12,615-21,215] higher overall healthcare expenditure, when compared to no chronic condition group. The excessive costs were mainly driven by increased inpatient service utilization.

Conclusions: The present study identified four chronic condition combinations, with distinct clinical trajectories, patterns of healthcare uses and expenditures.