Risk and prognosis analysis of osteoarticular tuberculosis in tuberculosis patients

Osteoarticular tuberculosis (OATB) is a major extrapulmonary tuberculosis subtype, but population-level risk and prognosis data remain insufficient for public health guidance. This study aimed to analyze risk factors and prognosis of OATB among tuberculosis (TB) patients. A hospital-based case-control study was conducted using data from the Infectious Disease Reporting Information System of the Chinese Center for Disease Control and Prevention (China CDC Information System). Between January 2014 and December 2020, 452 OATB cases and 1,168 non-OATB controls (selected by simple random sampling from 17,806 non-OATB patients) were included from Shanghai Pulmonary Hospital, a tertiary referral center for TB in Shanghai, China. Univariate and multivariate logistic regression analyses were used to identify factors associated with OATB. Cox regression was used to evaluate mortality risk factors. Female sex, older age, and recurrent TB were independently associated with OATB; drug resistance was inversely associated. Age ≥ 52.5 years predicted OATB (AUC = 0.764). OATB patients had higher mortality (HR = 2.342); diabetes further worsened prognosis (HR = 3.877). Older, female, and recurrent TB patients carry higher OATB risk. Routine bone/joint screening may be considered for those over 52.5 years, particularly in settings with adequate diagnostic resources, though validation in diverse populations is warranted. OATB predicts poorer prognosis, especially with diabetes, requiring intensified public health and clinical management.