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Gender differences in tuberculosis diagnosis, treatment and outcomes in Victoria, Australia, 2002-2015.

BACKGROUND
Gender has a significant impact on tuberculosis (TB) diagnosis and outcomes in many settings worldwide. We explored gender differences in Victoria, Australia, a low-incidence setting.


METHODS
Retrospective cohort study: 2002-2015. Gender was included as an independent variable in multivariate statistical analyses assessing TB management.


RESULTS
There were 2655 (54.5%) males and 2212 (45.5%) females notified (male:female ratio = 1.2:1). Among cases with pulmonary involvement, males underwent a chest X-ray or CT scan (CXR) sooner (hazard ratio [HR] 1.2, 95%CI 1.04-1.31, P = 0.010), began treatment sooner after presentation (HR 1.2, 95%CI 1.08-1.34, P = 0.001) and were more likely to have a sputum smear sample performed (OR 1.3, 95%CI 1.01-1.55, P = 0.037). Male cases with extra-pulmonary TB sought health care sooner after symptom onset (HR 1.3, 95%CI 1.03-1.58, P = 0.024) and were more likely to have an abnormal CXR (OR 1.9, 95%CI 1.54-2.32, P < 0.001). Males were more likely to die before or during treatment (OR 1.5, 95%CI 1.06-2.11, P = 0.024).


CONCLUSIONS
Women experienced small delays in management compared with men, with no obvious detriment to assessment results or treatment outcomes. Differences were consistent with the hypothesis that males manifest more severe disease at presentation, which could be related to a range of biological and social factors.