Comorbidity profiles and their impact on treatment outcomes in elderly patients with pulmonary tuberculosis: a single-center retrospective cohort study

BACKGROUND: This study aimed to characterize comorbidity distribution patterns and assess their clinical impact on therapeutic effectiveness in elderly pulmonary tuberculosis (PTB) patients, establishing an evidence base for risk-stratified clinical decision-making. METHODS: A retrospective cohort study was conducted among 1,340 hospitalized PTB patients (aged ≥ 60 years) from January 2020 to January 2024. Demographic characteristics, comorbidity data, and treatment outcomes were extracted from electronic medical records. Patients were categorized into treatment success (n = 1,105) and adverse outcome (n = 235) groups according to WHO criteria. Propensity score matching (PSM) was employed to balance baseline confounders, followed by multivariate logistic regression to evaluate associations between comorbidities and adverse outcomes. RESULTS: Comorbidities were prevalent in 81.64% (1,094/1,340) of patients, with stratification as follows: single comorbidity (30.67%, 411), dyad (26.64%, 357), triad (18.13%, 243), and complex multimorbidity (≥4 conditions: 6.19%, 83). The most frequent comorbidities were chronic heart diseases (31.12%), chronic lung diseases (27.84%), and hypertension (26.49%), followed by diabetes mellitus(20.30%) and psychiatric disorders (15.07%). The adverse outcome rate was 17.54% (235/1,340), comprising 98 treatment failures (7.31%), 89 deaths (6.64%), and 48 treatment terminations (3.58%).Multivariate analysis identified the following independent risk factors: diabetes mellitus(adjusted odds ratio [aOR]=2.73, 95% confidence interval [CI]:1.91-3.90), chronic kidney diseases (aOR = 6.31, 95% CI:4.00-9.96), active malignancy (aOR = 3.27, 95% CI:2.07-5.14), and multimorbidity (≥3 comorbidities; aOR = 1.71, 95% CI:1.20-2.46) (all p < 0.05). CONCLUSIONS: Elderly PTB patients exhibit a high comorbidity burden. Diabetes mellitus, chronic kidney diseases, active malignancy, and multimorbidity significantly increase the risk of adverse treatment outcomes. These findings underscore the necessity for multidisciplinary collaborative management models and early comorbidity screening to optimize clinical interventions. CLINICAL TRIAL NUMBER: Not applicable.