Factors associated with melioidosis mortality in Pahang from 2020-2024: data analysis using melioidosis registry from Pahang State Health Department.

Melioidosis is a severe infection caused by Burkholderia pseudomallei and is endemic in tropical regions, such as Southeast Asia. Favourable climate and substantial agricultural sectors contribute to a high incidence of melioidosis in Pahang, Malaysia. This study aims to identify factors associated with melioidosis mortality in Pahang from 2020 to 2024, with an emphasis on sociodemographic, occupational, clinical, and environmental determinants. A retrospective cohort study was conducted using the state-driven melioidosis registry. All confirmed cases between 2020 and 2024 were included in the analysis. All variables were extracted and analysed using simple and multiple logistic regression to identify the risk factors for melioidosis mortality. Out of 466 confirmed cases, 68 (14.6%) died from melioidosis. The median age was 48 years (IQR: 34-60), with the majority being male (76%) and originating from rural areas (71%). The incidence, mortality and case fatality rates fluctuated over the study period. The final regression model analysis identified three risk factors for mortality which include non-Malaysian ethnicity (aOR 3.27; 95% CI: 1.43-7.51), chronic obstructive pulmonary disease (COPD) (aOR 8.71; 95% CI: 1.11-68.39), and intensive care unit (ICU) admission (aOR 3.44; 95% CI: 1.91-6.17). In contrast, diabetes mellitus, which is often associated with increased risk of mortality, was not found to be significant in this study, nor was the level of monthly rainfall. These study findings highlight the need to address social determinants of health among vulnerable populations and to prioritise early recognition and management, especially for patients with COPD.