ArticleBMC infectious diseases2026
Clinical and social determinants of treatment outcomes in central nervous system tuberculosis in a high-resource setting: a retrospective cohort study.
Article in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLimited data are available regarding clinical and social determinants influencing treatment outcomes among patients with central nervous system (CNS) tuberculosis (TB) in high-resource settings.
methodsWe performed a retrospective cohort study of patients with CNS TB from January 2011 to June 2022 at the San Francisco Department of Public Health TB Clinic and the University of California, San Francisco Medical Center. Data were abstracted from cases of confirmed or suspected CNS TB treated with anti-TB therapy. Logistic regression models were used to identify sociodemographic and clinical factors associated with mortality and functional and cognitive impairment among survivors.
resultsOf 54 cases of CNS TB, 26% were microbiologically-confirmed. 31% resided in the top 3 deciles of social disadvantage. Over a mean follow-up of 10.2 months, cumulative mortality was 22%. Among survivors, 40% exhibited functional impairment and 38% demonstrated moderate to severe cognitive dysfunction. In adjusted models, having public insurance (aOR 14.94, 95% CI 1.58-141.29, p = 0.018) or residing in a highly deprived neighborhood (aOR 7.66, 95% CI 1.46–40.22, p = 0.016) was associated with functional and cognitive impairment, respectively. Additional risk factors for adverse clinical outcomes included older age, diabetes mellitus, severe disease at presentation (e.g., altered mentation, requiring intubation) and hydrocephalus.
conclusionsIn this high-resource setting, cumulative mortality and disability rates among patients treated for CNS TB were comparable to outcomes reported in studies from low and middle-income countries where TB is endemic. Although limited by the modest sample size, this study demonstrates a potential link between social disadvantage and poor CNS TB outcomes, highlighting persistent inequities in TB care even within a well-resourced health system. If these findings are confirmed in a larger study, implementing a comprehensive approach that addresses the social determinants of health affecting individuals at risk for TB will be essential to improving outcomes in this devastating infection.
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