Survival, recurrence, treatment failure, and mortality among tuberculosis patients in kermanshah province, Iran: a retrospective cohort study

Tuberculosis (TB) remains a major global public health challenge and is associated with substantial morbidity and mortality. This study investigated survival, recurrence, treatment failure, recovery, and mortality among TB patients in Kermanshah Province, Iran. In this retrospective cohort study, 2677 patients diagnosed with TB between 2009 and 2020 were included. Survival outcomes were assessed using Kaplan–Meier analysis and compared using the log-rank test. Cause-specific Cox proportional hazards models were applied to identify factors associated with recurrence, treatment failure, recovery, and mortality. Significant sex differences were observed in survival outcomes for recurrence ( p = 0.003), treatment failure ( p = 0.005), death ( p = 0.001), and recovery ( p = 0.001). A history of incarceration was associated with a higher hazard of disease recurrence (HR = 5.29, 95% CI 1.22–12.21). Compared with patients aged ≤ 30 years, those aged 41–50 years and 51–60 years had significantly higher hazards of death (HR = 3.42, 95% CI 1.06–11.01 and HR = 3.84, 95% CI 1.95–13.40, respectively). Female patients had a 58% lower hazard of death than males (HR = 0.42, 95% CI 0.19–0.94), while rural residents had a 67% lower hazard of death than urban residents (HR = 0.33, 95% CI 0.11–0.93). Age, sex, place of residence, and history of incarceration were significant predictors of TB outcomes. Older adults, males, urban residents, and individuals with a history of imprisonment experienced less favorable outcomes. These findings highlight the need for targeted TB control strategies focused on high-risk populations to improve survival and reduce adverse outcomes.