The impact of TB on the risk of bronchiectasis: a nationwide cohort study

Abstract

BACKGROUND : Post-TB lung disease contributes substantially to long-term morbidity, with bronchiectasis being a frequent sequela. However, its incidence and risk factors at the population level remain poorly defined. METHODS : We conducted a nationwide cohort study including 12,626 TB survivors diagnosed between 2013 and 2017, matched 1:3 by age and sex to 37,878 controls. Participants were followed until bronchiectasis diagnosis, death, or December 2018. Incidence, relative risks, and risk factors were assessed. RESULTS : During a median follow-up of 5.4 years, 875 bronchiectasis cases occurred. TB survivors showed a higher incidence than controls (7.09 vs. 1.98 per 1,000 person-years; P < 0.001) and a 2.68-fold elevated risk (95% confidence interval, 2.30-3.11). Risk was particularly elevated in younger individuals (<60 years, adjusted hazard ratio [aHR] 3.06), never-or light smokers (aHR 2.91-3.89), those with low comorbidity burden (aHR 3.39), and those without chronic airway disease (aHR 2.93). Within TB survivors, age >= 60 years, low body mass index, low income, and chronic airway disease were independent risk factors of bronchiectasis. CONCLUSION : TB survivors had a markedly higher risk of bronchiectasis, highlighting the importance of vigilant follow-up and preventive strategies to reduce long-term respiratory complications.