Abstract
In 1975, the Tuberculosis Research Committee (Ryoken) conducted its first study on long-term hospitalized TB patients who had been staying in a hospital for more than five years. Similar studies were repeated in 1981 (hospitalized for more than three years), 1988 (hospitalized for more than two years), 1993 and 1998 (hospitalized for more than one year). The same patient cohorts in each study were followed up, each after a differ-ent time period, i. e., after 68 months for the 1975 study cohort, 36 months for the 1981 study cohort, 26 months for the 1988 study cohort, and 74 months for the 1993 study cohort. Based on the results of these series of studies, changes in the patients' characteristics and factors related to long-term hospitalization during the last 23 years were analyzed. The main findings are summarized below.
1) The proportion of patients who stayed in a hospital for more than one year in the study decreased from 41.6% in 1975 to 9.5% in 1998.
2) The long-term hospitalized patients have become older, are more likely to be previously untreated cases, and initially bacillary cases.
3) The major cause of the treatment failure among the long-term hospitalized cases as reported by the attending doctors was “too chronic disease” in the earlier years, but the causes have changed to adverse reactions to anti-TB drugs, initial drug-resistance, and patient's poor compliance or non-adherence to treatment in recent years.
4) The cause of the long-term hospital stay after bacteriological negative conversion was chronic respiratory failure in more than one third of the patients in every study. Among these patients, an increasing proportion of cases has non-medical problems, such as poor family acceptance and reluctance to be discharged.
5) The mortality of the long-term hospitalized cases was generally high. Among bacteriologically positive cases in the study, it was 14% to 19% annually, and tuberculosis deaths occupied 60% to 80% of all the deaths.
6) The outcomes of those patients who were eventually discharged has become less favorable. Only 3% of them were returned to light work in the 2000 study, while 15% did in the 1981 study.
