Male sex is associated with worse microbiological and clinical outcomes following tuberculosis treatment: A retrospective cohort study, a systematic review of the literature, and meta-analysis.

BACKGROUND Although the incidence of tuberculosis (TB) is higher in males compared to females, the relationship of sex with TB treatment outcomes has not been adequately studied. METHODS We performed a retrospective cohort study and a systematic review and meta-analysis of observational studies during the last 10 years to assess sex differences in clinical and microbiological outcomes in tuberculosis. RESULTS In our cohort of 2,894 patients with drug-susceptible pulmonary TB (1,975 males and 919 females), males had higher adjusted hazards of 9-month mortality due to all causes (HR 1·43,95%CI 1.03-1.98) and infections (HR 1.70, 95%CI 1.09-2.64) and higher adjusted odds ratio for 2-month sputum culture positivity (OR 1.56,95%CI 1.05-2.33) compared to females. Smear positivity at 2 months was not significantly different (OR 1.27, 0.71-2.27) between the sexes. Among 7,896 articles retrieved, 398 articles were included in our systematic review describing a total of 3,957,216 patients. The odds of all-cause mortality were higher in males compared to females in the pooled unadjusted (OR 1.26, 95%CI 1.19-1.34) and adjusted (OR 1.31, 95%CI 1.18-1.45) analyses. Males had higher pooled odds of sputum culture (OR 1.44,95% CI 1.14-1.81) and sputum smear (OR 1.58,95%CI 1.41-1.77) positivity, both at the end of the intensive phase and upon treatment completion. CONCLUSIONS Our retrospective cohort showed that male TB patients have higher 9-month all-cause and infection-related mortality, with higher 2-month sputum culture positivity after adjusting for confounding factors. In our meta-analysis, males showed higher all-cause and TB-related mortality and higher sputum culture and smear positivity rates during and after TB treatment.