Multicenter observational cohort links symptom subtypes with medication adherence in older pulmonary tuberculosis patients

A prospective multicenter observational cohort study of 300 newly diagnosed older patients with pulmonary tuberculosis identified three symptom subtypes during the intensive phase of treatment and found that the group with high psychogastrointestinal symptoms had the lowest rate of good medication adherence. The findings were reported for patients recruited consecutively from four tuberculosis wards at Nantong Sixth People’s Hospital and Nanjing Gaochun People’s Hospital between September 1 and December 31, 2025.

At the end of the first month of anti-tuberculosis treatment, researchers assessed 17 symptoms using the Pulmonary Tuberculosis Patient Symptom Cluster Assessment Scale. Latent class analysis identified a low symptom burden subtype in 128 patients, or 42.7%; a high psychogastrointestinal symptoms subtype in 92 patients, or 30.7%; and a high respiratory symptoms-dominant subtype in 80 patients, or 26.6%. The psychogastrointestinal subtype was characterized by the co-occurrence and high burden of depression, anxiety, nausea and vomiting, while the respiratory subtype was characterized by a high burden of respiratory symptoms.

Medication adherence was assessed in the third month of treatment among 285 patients who completed follow-up, using the researchers’ self-developed and validated Treatment Adherence Scale for Tuberculosis. A score above 36 points was classified as good adherence. The good-adherence rate was 45.7% in the high psychogastrointestinal symptoms group, 60.0% in the high respiratory symptoms-dominant group and 77.3% in the low symptom burden group; the difference among the three groups was significant at P<0.001. Univariate and multivariable logistic regression analyses examined associations between symptom subtype and good adherence.

After adjustment for confounding factors, the high psychogastrointestinal symptoms subtype had the strongest reported association with poor adherence. Its adjusted odds ratio for good adherence was 0.24, with a 95% confidence interval of 0.13–0.45 and P<0.001, indicating lower odds of good adherence than in the low symptom burden group. Coexisting diabetes mellitus was also independently associated with lower odds of good adherence, with an adjusted odds ratio of 0.52, a 95% confidence interval of 0.28–0.97 and P=0.037. These results show associations, not causal effects. The study was limited to newly diagnosed older inpatients with pulmonary tuberculosis in four wards at two hospitals, and adherence was assessed once during the first three months of treatment. Fifteen enrolled patients did not complete the adherence follow-up, leaving 285 participants in that analysis. The reported findings do not establish that symptom patterns cause nonadherence or that the associations will generalize to other populations and settings.

Subject of Research: Symptom subtypes and medication adherence among older patients with pulmonary tuberculosis

Article Title: Classification of older pulmonary tuberculosis patients based on symptom clusters and differences in medication adherence: a latent class analysis

Article References: Cai, Y., Cheng, X., & Rui, Y. (2026). Classification of older pulmonary tuberculosis patients based on symptom clusters and differences in medication adherence: a latent class analysis. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14486-x

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14486-x

Keywords: pulmonary tuberculosis, older patients, medication adherence, symptom clusters, latent class analysis, psychogastrointestinal symptoms, respiratory symptoms, observational cohort, multicenter study, Classification, older, pulmonary