Impact of Mass Screening Using Chest X-Ray on Mortality Reduction and Treatment Adherence Among Pulmonary Tuberculosis Patients

Background: Evaluate the impact of chest X-ray (CXR) screening on mortality and treatment adherence by comparing pulmonary tuberculosis (PTB) cases detected through screening and those routinely diagnosed at healthcare facilities. Methods: A retrospective analysis of 10% randomly sampled National Health Insurance Service claims data assessed PTB cases diagnosed during 2004-2020. Patients were categorized as 'screening-detected (ACF, active case finding)' or 'routinely detected (PCF, passive case finding)' based on CXR screening history. Cox proportional hazards model determined the association between screening and all-cause or tuberculosis (TB)-specific mortality. Treatment adherence was also measured. Results: Among 84,828 PTB patients, 18.76% were ACF (15,916), and 81.24% were PCF (68,912). ACF exhibited lower risks in all-cause mortality (adjusted hazard ratio [aHR], 0.70; 95% confidence interval [CI], 0.67-0.73) and TB-specific mortality (aHR, 0.38; 95% CI, 0.32-0.46) compared to PCF. In the ACF group, 91.39% initiated anti-TB treatment, with 45.99% adherence. For PCF, 92.87% initiated treatment, and only 45.44% were adherent. Conclusion: Individuals undergoing CXR screening have a lower risk of both all-cause and TB-specific mortality compared to PCF, but treatment adherence is similar between the two groups, emphasizing the need to improve the linkage between screening, diagnosis, and treatment for the screened population.