Factors associated with mortality from tuberculosis in Iran: an application of a generalized estimating equation-based zero-inflated negative binomial model to national registry data

OBJECTIVES: Tuberculosis (TB) is a global public health problem that causes morbidity and mortality in millions of people per year. The purpose of this study was to examine the relationship of potential risk factors with TB mortality in Iran. METHODS: This cross-sectional study was performed on 9,151 patients with TB from March 2017 to March 2018 in Iran. Data were gathered from all 429 counties of Iran by the Ministry of Health and Medical Education and Statistical Center of Iran. In this study, a generalized estimating equation-based zero-inflated negative binomial model was used to determine the effect of related factors on TB mortality at the community level. For data analysis, R version 3.4.2 was used with the relevant packages. RESULTS: The risk of mortality from TB was found to increase with the unemployment rate ([Formula: see text] =0.02), illiteracy ([Formula: see text] =0.04), household density per residential unit ([Formula: see text] =1.29), distance between the center of the county and the provincial capital ([Formula: see text] =0.03), and urbanization ([Formula: see text] =0.81). The following other risk factors for TB mortality were identified: diabetes ([Formula: see text] =0.02), human immunodeficiency virus infection ([Formula: see text] =0.04), infection with TB in the most recent 2 years ([Formula: see text] =0.07), injection drug use ([Formula: see text] =0.07), long-term corticosteroid use ([Formula: see text] =0.09), malignant diseases ([Formula: see text] =0.09), chronic kidney disease ([Formula: see text] =0.32), gastrectomy ([Formula: see text] =0.50), chronic malnutrition ([Formula: see text] =0.38), and a body mass index more than 10% under the ideal weight ([Formula: see text] =0.01). However, silicosis had no effect. CONCLUSIONS: The results of this study provide useful information on risk factors for mortality from TB.