Association Studies of Age-Specific Determinants, Nutritional Status, and Treatment Non-Compliance Determinants for Pulmonary Tuberculosis in Indonesia

Background: Pulmonary TB (PTB) is a major global public health issue, particularly in Indonesia, which ranks among the countries with the highest TB burdens worldwide. Despite advances in diagnostic tools and standardized treatments, considerable variation persists in PTB risk, nutritional susceptibility, and treatment compliance over the life course. Prior Indonesian research has treated age primarily as a confounding variable. Moreover, these studies have not comprehensively examined age-specific determinants, the full range of nutritional status, or age-related factors influencing non-compliance with anti-TB treatment, using nationally representative data. This research aims to address these gaps by examining age-specific factors influencing PTB, the relationship between nutritional status and PTB in school-aged children, and factors associated with treatment non-compliance across several age cohorts in Indonesia.

Materials and Methods: This study used secondary data from the 2018 Indonesian Basic Health Research Survey (RISKESDAS), a cross-sectional survey conducted across 34 provinces to ensure national representativeness. In total, there were three distinct analytical examinations. The first study included 715,394 adults aged 16 and older to assess age-specific characteristics related to PTB. The second study examined the correlation between body mass index (BMI) and PTB in 230,582 school-aged children aged five to eighteen years. Study III sought to identify determinants of non-compliance with anti-TB medication among 1,354 TB patients aged 16 and older. Several statistical approaches, including survey-weighted descriptive analyses, Rao-Scott chi-square tests, and multivariable logistic regression models, were employed to assess the influence of age and nutritional status on the modification of the effect.

Results: The prevalence of PTB rose significantly with age, increasing from 3.5‰ among those aged 16-45 years to 9.6‰ among those aged 65 years and older. Across age groups, underweight status, previous smoking, diabetes mellitus (DM), and heart disease were consistently associated with higher PTB prevalence, whereas overweight/obesity showed a protective association. The magnitude and pattern of these associations varied by age group, indicating that age is an effect modifier rather than merely a confounder. In school-aged children, undernutrition was significantly associated with PTB, with notable interactions between underweight status and sociodemographic variables. Treatment non-compliance varied across age groups and correlated with sociodemographic, behavioral, and clinical variables, including work status, educational attainment, BMI, comorbid conditions, and the presence of a directly observed therapy (DOT) supervisor.

Conclusion: Our studies show that PTB and treatment noncompliance in Indonesia are significantly influenced by age and shaped by interrelated social, behavioral, and clinical factors. Undernutrition remains a significant modifiable factor associated with PTB throughout life, and age-specific trends underscore the need for tailored TB preventive and care programs. Incorporating age-specific assessment, nutritional interventions, and customized compliance support into national TB programs could significantly improve TB control outcomes in Indonesia.