Menarcheal age in Turkey: Secular trend and socio-demographic correlates

Background: Menarche is an important indicator for assessing the developmental status of pubertal girls. Despite its importance, there is no nationwide information on menarcheal age in Turkey.

Aim: This paper is the first attempt to examine age at menarche for Turkey as a whole. The aim is to present the secular trend of menarcheal age and variations across different socio-demographic groups.

Methods: Data were employed from the Turkey Demographic and Health Survey, 2008. Mean menarcheal ages were estimated for birth cohorts and socio-demographic sub-groups. The pace of decline in menarcheal age has been estimated using multiple linear regression analysis, controlling for year of birth and other variables.

Results: Mean age at menarche was estimated as 13.30 (95% CI = 13.26–13.35). It was estimated as 13.17 years (95% CI 12.95–13.38) for the youngest birth cohort (1989–1993), as opposed to 13.44 (95% CI 13.37–13.52) years for the cohort born in 1959–1968.

Conclusion: Regression analysis indicated a decrease of 1.44 months per decade, providing evidence of a secular trend in menarcheal age in Turkey. Further results suggested childhood place of residence, education, welfare status and number of siblings to be significantly associated with menarcheal age.     

Trend of Menarcheal Age among Korean Girls

BackgroundMenarcheal age has been decreasing worldwide. However, few recent studies have observed trends in menarcheal age in larger populations, and the cutoff age for early menarche remains unclear. Therefore, we aimed to analyze recent trends of menarcheal age and to determine the cutoff age of early menarche based on nationally representative data.MethodsWe conducted a cross-sectional study of 351,006 Korean girls aged 12–18 years who were born in 1988–2003 based on the data of the 2006–2015 Korea Youth Risk Behavior Survey. We identified the distribution of age at menarche using the complex sample Cox regression model. Trends in the prevalence of early menarche were determined using the complex sample linear model.ResultsNinety-five percent of all the participants reported they had experienced menarche. The mean menarcheal age was 13.0 years (95% confidence intervals [CIs], 12.92–13.04) for girls born in 1988 and decreased to 12.6 years (95% CI, 12.54–12.61) for girls born in 2003. The cutoff age (the 3rd percentile value) for early menarche was 10.5 years during the study period. The prevalence of early menarche significantly increased from 1.8% in 2006 to 3.2% in 2015 (P-for-trend < 0.001). Downward trends of menarcheal age were noted across all body mass index groups, and this trend was most prominent in the obese group.ConclusionWe reported an ongoing downward trend in menarcheal age in Korean girls born in 1988–2003, decreasing by 0.4 years over the 15 years.     

Age at menarche and the evidence for a positive secular trend in urban South Africa

Menarcheal age was estimated for 287 (188 Black; 99 White) urban South African girls born in Soweto‐Johannesburg in 1990. The median menarcheal age for Blacks was 12.4 years (95% confidence interval (CI) 12.2, 12.6) and 12.5 years (95% CI 11.7, 13.3) for Whites. Data from six studies of menarcheal age, including the current study, were analyzed to examine the evidence for a secular trend between 1956 and 2004 in urban South African girls. There was evidence of a statistically significant secular trend for Blacks, but not Whites. Average menarcheal age for Blacks decreased from 14.9 years (95% CI 14.8, 15.0) in 1956 to 12.4 years (95% CI 12.2, 12.6) in the current study, an average decline of 0.50 years per decade. Fewer data were available for Whites, but average menarcheal age decreased from 13.1 years (95% CI 13.0, 13.2) in 1977 to 12.5 years (95% CI 11.7, 13.3) in the current study, an average decline of 0.22 years per decade. The diminishing age at menarche and the current lack of difference between Blacks and Whites is probably reflective of the continuing nutritional and socio‐economic transition occurring within South Africa. Am. J. Hum. Biol., 2009. © 2008 Wiley‐Liss, Inc.     

Secular change in age at menarche in rural Oaxaca, southern Mexico: 1968--2000

OBJECTIVE: To evaluate secular change in the age at menarche between 1978 and 2000 in residents of a rural Zapotec-speaking community in Oaxaca, southern Mexico, using status quo and retrospective methods. MATERIALS AND METHODS: Status quo menarcheal status of girls 9-18 years of age in 1978 (n= 101) and 2000 (n=238) and retrospective ages at menarche of adult women 19+ years of age in 1978 (n = 228) and 2000 (n = 246) were obtained via interview. Probit analysis was used to estimate median ages at menarche and 95% confidence intervals (CI) for the status quo data. Analysis of variance and linear regression was used to compare the retrospective data across surveys. RESULTS: The median ages at menarche of adolescents are 14.8+/-1.2 years (0.24 year, 95% CI 14.2-15.4 years) in 1978 and 13.0+/-1.0 years (0.10 year, 95% CI 12.7-13.3 years) in 2000. Age at menarche has declined by 1.8 years over about 23 years, 0.78 year/decade (95% CI = 0.65-0.91 year/decade). Recalled ages at menarche do not differ by age group in the 1978 survey, but differ significantly by age group in the 2000 survey (p <0.001). Within the 2000 survey, the two youngest age groups (< 29, 30-39 years) do not differ, but attain menarche earlier than women in the four older age groups (p < 0.05), who do not differ from each other in age at menarche. The estimated rates of secular decline in age at menarche in adult women vary between 0.38 and 0.42 years/decade (0.26-0.56 year/decade). CONCLUSIONS: There is a major secular decline in the age at menarche of adolescent girls and young adult women between 1978 and 2000. The estimated rate of decline in adult women is about one-half of that in adolescent girls. The secular decline in age at menarche is consistent with corresponding secular gains height, sitting height and estimated leg length of children and adolescents in the community; corresponding secular gains are smaller in young adults 19-29 years.     

Age at menarche in Peruvian girls at sea level and at high altitude: Effect of ethnic background and socioeconomic status

The objective of the present study was to determine median age at menarche using the status quo method and the independent effects of ethnic background and socioeconomic status on the age at menarche in Peruvian girls from two distinct levels at altitude: Lima (150 m) and Cerro de Pasco (4,340 m). The sample included 503 girls from Lima and 625 girls from Cerro de Pasco, ages 10–18 years. Ethnic background was determined by four parental surnames. Subjects were classified as Quechua when one or more surnames were from Quechua origin and Spanish when four surnames were from Spanish origin. Socioeconomic status was determined using a socioeconomic index score and subjects were classified as belonging to the middle-low, low, or very low class. Median age at menarche was calculated by survival analysis using the Life Table Method with a 95% Confidence Interval (CI). Among Quechua and Spanish girls, age at menarche occurred later at high altitude than at sea level. Median ages at menarche for the overall groups were 13.08 (12.91–13.25, 95% CI) years in Lima and 14.33 (14.17–14.48, 95% CI) years in Cerro de Pasco (P < 0.0001). Socioeconomic status had no significant effect on menarcheal age (P > 0.05). Controlling socioeconomic status in the design, median age at menarche was still higher at high altitude than at sea level (P < 0.05). After logistic regression analysis, an effect on age at menarche of chronological age and place of residence was observed, but not by ethnic background, socioeconomic status and not by interactions of age and place of residence, age and socioeconomic status, place of residence and socioeconomic status, place of residence and ethnic background, or socioeconomic status and ethnic background. Thus later age at menarche observed in girls at high altitude is not due the differences in ethnicity or socioeconomic status. © 1996 Wiley-Liss, Inc.     

Variability of reproductive history across the Swiss SAPALDIA cohort – Patterns and main determinants

Background: Reproductive characteristics play an aetiological role for many diseases, including reproductive cancers. They have been shown to vary internationally and nationally, but have not yet been described for the whole Swiss population.

Aim: The study investigated the variability of reproductive characteristics, their patterns, and main determinants across a population-based female study population in Switzerland.

Methods: Reproductive characteristics obtained from 3119 women (28–72 years) participating in the SAPALDIA cohort survey in 2001–2003 are described across birth cohorts, study areas, language regions, and levels of urbanization. Determinants of age at menopause were analysed by Cox regression.

Results: Reported median age at menarche was 13 years and median age at natural menopause was 52 years. The prevalence of nulliparity was 27%, and the fertility rate 1.6. Across birth cohorts there was a decline of menarcheal age and fertility rates, and an increase of nulliparity and age at last pregnancy. All characteristics varied across study areas, language regions, and levels of urbanization. Smoking, parity, and physical exercise were stronger predictors of earlier (<52 years) than older (>52 years) menopausal age.

Conclusion: Reproductive events show secular and geographic variation within Switzerland. Smoking, parity and physical activity significantly predict age at natural menopause, particularly before age 52. The secular trend of earlier menarche and increased nulliparity may result in a higher risk of reproductive cancers in younger generations.     

Timing of pubertal growth and menarche in indigenous Qom girls of Argentina

Background: Pubertal timing is in part mediated by environmental factors, with greater energy availability often associated with earlier or more rapid development. Many indigenous populations are undergoing socioeconomic change that may affect pubertal development and related health risks, necessitating fundamental longitudinal research on growth and development in these populations.

Aim: Growth velocity and time to menarche among peri-urban indigenous Qom (Toba) girls in Argentina are described.

Subjects and methods: From 2011–2015, monthly anthropometrics and menstrual status were collected from 61 Qom girls aged 7–14. Growth velocity curves were generated using the ‘Super-imposition by translation and rotation’ (SITAR) method. Median time to menarche was estimated by Kaplan-Meier survival analysis.

Results: Mean ages at peak height, weight and BMI velocity were estimated at 10.8, 10.5 and 10.7?years and median age at menarche at 11.6?years (95% CI?=?11.4–11.9). At menarche, 45% of girls were overweight or obese and only one participant was short-statured by international standards.

Conclusion: Qom participants in this study exhibit relatively fast pubertal development as compared to other Latin American indigenous populations studied previously by others. Genetic and environmental factors influencing body size, diet and/or activity levels should be investigated further in this population.     

Age of menarche and nutritional status of indigenous and non-indigenous adolescents in the Araucanía Region of Chile

Abstract

Background: Early onset of menarche has been linked to prevalence of obesity; however, this may differ for indigenous females.

Objective: To analyse the relationship between age of menarche and nutritional status among indigenous and non-indigenous girls.

Method: The design of this study was cross-sectional. Date of menarche was determined through interviews, and all responses were confirmed by the girls' mothers. A total of 8504 adolescents were screened for recent menarche. One hundred and thirty-one girls of Mapuche (indigenous) and 143 girls of Chilean–Spanish background were identified and evaluated by anthropometric measurements.

Results: Median age of menarche was 150 months, interquartile range (IR) 143–157 in indigenous, and 145.5 months, IR 139–153 in non-indigenous girls (p = 0.04). The indigenous females showed a higher prevalence of overweight (36.4% vs 23.1%), although the frequency of obesity was similar (16.8% vs 16.3%). For indigenous girls, age of menarche was delayed by 2.69 months (confidence intervals (CI) –0.38 to 5.77). It was observed that girls with overweight experienced age of menarche 7.59 months earlier than those with normal weight, CI –10.78 to –4.41. In the analysis of obesity, the effect on age of menarche was similar, with onset 7.53 months earlier than for the normal weight, CI –11.34 to –3.72.

Conclusion: Age of menarche is younger than has been previously reported and occurs earlier in girls with overweight and obesity, while being indigenous was not related.     

A continuous decline in menarcheal age in Denmark

We report a renewed decline in mean menarcheal age in a large Danish sample after a period with a halt in the trend towards earlier age at menarche in many North European countries. In our study based on retrospective data from six different samples constituting 42784 women, we find a continuously declining mean menarcheal age in Denmark among women born in the years 1964-1973. In a sample of textile workers born in the years 1939-1968 (n = 12605) we find a 1 year higher mean menarcheal age. This indicates that menarcheal age is still delayed in certain groups in Denmark. This leaves the possibility that the menarcheal age could fall even further in the future.     

Secular trend in the age at menarche in Haiti

Trends in age at menarche of 10,563 pregnant Haitian women enrolled in a longitudinal study of maternal mortality are examined. Mean recalled age at menarche for adult women in the sample was 15.37 years. However, there was a clear decline in mean menarcheal ages from the oldest to the youngest women, with a mean rate of decline for adult women of 0.36 years per decade. Mean menarcheal age was higher in each age group of rural women than for women in the metropolitan Port-au-Prince area; the rate of decline for adult rural women (0.37 years per decade) was nonsignificantly higher than that for adult metropolitan women (0.30 years per decade). The data suggest a secular decline in age at menarche in Haiti, as well as a continuing disparity between metropolitan and rural women. A declining age at menarche has important implications for fertility and reproductive health in Haiti, and may reflect a gradual improvement in health and nutritional status. © 1995 Wiley-Liss, Inc.     

Age at menarche and an analysis of secular trends in menarcheal age of South African urban and rural black females

Age at menarche was estimated using status quo techniques on a sample of 230 rural South African females aged 11 to 17 years. Mean age of menarche was 14.03 years (SD = 1.25 years). Compared with contemporary rural and well-off urban samples, these females experienced menarche 0.6 years earlier than did the rural sample and 0.8 years later than the well-off urban group. Data from 11 previously reported studies of menarcheal age in urban and rural girls were analyzed with these data to determine the existence and magnitude of secular trends and whether rates differed between urban and rural environments. Regression analysis demonstrated a clear secular trend in both urban and rural females since 1943. Menarcheal age decreased at a rate of 0.34, 0.73, and 0.46 years per decade for rural, urban, and combined groups, respectively. The decline in menarcheal age over the last 40 years is thought to be due to improving socioeconomic conditions, but differences between urban and rural groups remain. Within rural groups there appears to be considerable variation in menarcheal age.     

Early life undernutrition and adolescent pregnancy outcome in rural India

Abstract

Background: In poor communities of the Third World, adolescent pregnancy outcomes are likely to be worse in view of the prevailing chronic undernutrition.

Aim: The study examined the confounding effect of early life undernutrition on adolescent pregnancy outcome in rural India.

Subjects and methods: Retrospective information on socio-economic, demographic and anthropometric variables, gynaecological and obstetric history, pregnancy outcome and birth weight was obtained on 326 primigravid young married rural girls during 1998–2001.

Results: Prevalence of pregnancy wastage (stillbirths and abortions) reduced significantly (p <?0.01) with increase in age at first conception. The risk for pregnancy wastage observed (OR = 1.95, 95% CI = 0.91–4.21) in mothers with early conception (<17.25 years) increased significantly to 4.24 (95% CI = 1.4–12.86) in case of girls with delayed menarcheal age (≥14.5 years) or to 14.2 (95% CI = 1.17–173.2) if they had higher post-menarcheal stature growth (≥4 cm). Similarly, risk for preterm delivery (OR = 2.18, 95% CI = 0.88–5.42) observed among mothers with early conception increased to 36.6 (95% CI = 3.57–374.0) if they had significant post-menarche gain in height. Our findings thus indicate that pregnancy outcome was adversely affected by early conception and prolonged adolescent growth, which are the features of biological immaturity in undernourished populations.

Conclusion: Our findings indicate that in view of prevailing socio-cultural conditions, good nutrition in early life for girls is essential to prevent post-menarcheal height growth while health education programmes are essential to prevent early conception in rural India. These observations have wider implications for similar rural settings especially in other developing countries.     

A comparative analysis of estimation of age at menarche by various methods in women participating in the Krakow Longitudinal Growth Study, Poland.

The purpose of this study was to see whether menarcheal age assessment by means of the most frequently used methods that were conducted every time on the same group of girls would yield the same results. One hundred and one Polish girls, whose ages at menarche were recorded in a longitudinal study between 1976 and 1990, were asked to recall the age of menarche in 2004. The mean menarcheal ages of those women were calculated by means of the probit (PA), prospective (AA), retrospective method without age correction (RA), and retrospective method with the recall age corrected by 0.5 year (RcA). The PA, AA, and retrospective methods: RA and RcA revealed results: 13.14 +/- 1.1; 13.10 +/- 1.1; 13.12 +/- 1.36, and 14.39 +/- 1.34 years, respectively. The menarcheal AA was insignificantly different from the PA (95% CI) and RA. The RcA was significantly higher than the AA and RA (P = 0.05). The correlation coefficient (r) between AA and RA was 0.70. Only 16% of the interviewed women accurately remembered the date of their menarche, 63% of them missed their menarche time by about 1 year, whereas 22% were wrong by 2 and more years. (1) The PA and the AA method yield comparable results when estimating menarcheal age. (2) The menarcheal age determined by the retrospective methods is not very reliable and the application of age correction overestimates the results.     

Age at menarche in Iran

Background : Age at menarche and its potential associated factors are reported for 1862 Shiraz (Southern Iran) secondary school girls taking part in a cross-sectional survey selected from the four educational districts of the city. Methods : Probit analysis was used to estimate age at menarche, principal component analysis (PCA) was applied to analyse socio-economic status (SES). Body mass index (BMI) was used as an indicator of nutrition. Results : Mean &#45 SD age at menarche was 12.91 &#45 1.23 years (95% CI: 12.84-12.97). Of all subjects, 33.7% first menstruated in summer. The highest mean age at menarche was 13.01 years in winter. Stress, anxiety and discomfort was seen among 70.3% of subjects at menarche indicating total or partial ignorance of the menstruation phenomenon. Age at menarche decreased as SES improved. Menarcheal age was delayed for underweight subjects. Conclusions : It is concluded that BMI and SES had the most significant effects on variation of menarcheal age in a unified statistical model. However, their interaction was found to be not statistically significant.     

The impact of carbapenemase-producing Enterobacteriaceae colonization on infection risk after liver transplantation: a prospective observational cohort study

ObjectiveTo investigate the impact of colonization with carbapenemase-producing Enterobacteriaceae (CPE) on the CPE infection risk after liver transplantation (LT).MethodsProspective cohort study of all adult patients undergoing LT at our centre over an 8-year period (2010–2017). Individuals were screened for CPE colonization by rectal swabs at inclusion onto the waiting list, immediately before LT and weekly after LT until hospital discharge. Asymptomatic carriers did not receive decolonization, anti-CPE prophylaxis or pre-emptive antibiotic therapy. Participants were followed up for 1 year after LT.ResultsWe analysed 553 individuals who underwent a first LT, 38 were colonized with CPE at LT and 104 acquired colonization after LT. CPE colonization rates at LT and acquired after LT increased significantly over the study period: incidence rate ratios (IRR) 1.21 (95% CI 1.05–1.39) and 1.17 (95% CI 1.07–1.27), respectively. Overall, 57 patients developed CPE infection within a median of 31 (interquartile range 11–115) days after LT, with an incidence of 3.05 cases per 10 000 LT-recipient-days and a non-significant increase over the study period (IRR 1.11, 95% CI 0.98–1.26). In multivariable analysis, CPE colonization at LT (hazard ratio (HR) 18.50, 95% CI 6.76–50.54) and CPE colonization acquired after LT (HR 16.89, 95% CI 6.95–41.00) were the strongest risk factors for CPE infection, along with combined transplant (HR 2.60, 95% CI 1.20–5.59), higher Model for End-Stage Liver Disease at the time of LT (HR 1.03, 95% CI 1.00–1.07), prolonged mechanical ventilation (HR 2.63, 95% CI 1.48–4.67), re-intervention (HR 2.16, 95% CI 1.21–3.84) and rejection (HR 2.81, 95% CI 1.52–5.21).ConclusionsCPE colonization at LT or acquired after LT were the strongest predictors of CPE infection. Prevention strategies focused on LT candidates and recipients colonized with CPE should be investigated.     

The age of menarche in Nigerian urban school girls

In March and April 1978, a sample of 1365 girls from three secondary schools within and near Enugu (capital of Anambra State of Nigeria) were interviewed regarding date of birth and menstrual status. Using probit analysis, the mean age at menarche was 13.54 +/- 0.07 years, implying, when compared with earlier studies, a rate of decline in the average menarcheal age of about four months per decade. Significant differences were observed in the menarcheal ages of the girls with respect to their geographical residence and the occupation of their fathers. The results obtained in the study are similar to those reported by Oduntan et al. (1976) for south-western Nigeria, and they lend support to the proposition that improvements in nutrition and the elimination of infectious diseases (characteristic associated with socioeconomic development) tend to reduce the average menarcheal age.     

Pseudomonas aeruginosa and lung function decline in patients with bronchiectasis

ObjectivesThe objective of this study was to analyse lung function decline over time in bronchiectasis, along with the factors associated with it.MethodsSpirometry was measured every year in this observational, prospective study in 849 patients from the Spanish Bronchiectasis Registry (RIBRON). The main outcome was the decline in the rate of forced expiratory volume during the first second (FEV1). To be included in this study, patients needed a baseline assessment and at least one subsequent assessment. FEV1 decline was analysed using a mixed-effects linear regression model adjusted for clinically significant variables.ResultsWe recruited 849 bronchiectasis patients with at least two annual lung function measurements (follow-up range 1–4 years). A total of 2262 lung function tests were performed (mean 2.66 per patient, range 2–5). Mean baseline FEV1 was 1.78 L (standard deviation (SD) 0.76; 71.3% predicted). Mean age was 69.1 (SD 15.4) years; 543 (64% women. The adjusted rates of FEV1 decline were –0.98% predicted/year (95% confidence interval (CI) –2.41 to –0.69) and –31.6 (95% CI –44.4 to –18.8) mL. The annual FEV1 decline was faster in those patients with chronic bronchial infection by Pseudomonas aeruginosa (–1.37% (52.1 mL) vs –0.37% (–24.6 mL); p < 0.001), greater age, increased number of severe exacerbations in the previous year and higher baseline FEV1 value.DiscussionIn patients with bronchiectasis, the annual rate of FEV1 decline was –31.6 mL/year and it was faster in older patients and those with chronic bronchial infection by P. aeruginosa, increased number of previous severe exacerbations and higher baseline FEV1 value.     

Current in-hospital management for patients with tuberculosis in a high-income country: a retrospective cohort study

ObjectivesIn Japan, most cases of tuberculosis (TB) occur among individuals aged 65 years or older. However, data on in-hospital adverse events (AEs) associated with TB management, especially in high-income nations with an ageing population, are scarce. The present study aimed to scrutinize the current TB unit practices, incidence of in-hospital AEs and predictors of in-hospital mortality.MethodsThis retrospective cohort study was conducted at a tertiary care centre in Tokyo, Japan from 2012 to 2017. Inpatients with the diagnosis of TB and aged >18 years were included. Quality of in-hospital care and factors associated with in-hospital mortality were investigated using multivariate logistic regression analysis.ResultsIn total, 448 patients were enrolled. The in-hospital mortality rate was 16.7% (75/448). Miliary/disseminated TB was common (59/448, 13.2%), especially in those who died (17/75, 22.7%). Factors independently associated with in-hospital mortality were a low Karnofsky performance status score on admission (score: 40-10, adjusted odds ratio (aOR) 25.65, 95% CI 5.63–116.92 and score: 70-50, aOR 9.47, 95% CI 2.07–43.3), age over 89 years (aOR 3.68, 95% CI 1.08–12.46), Charlson Co-morbidity Index >5 (aOR 3.56, 95% CI 1.37–9.21), development of any health-care-associated infection (aOR 2.95, 95% CI 1.35–6.41), and development of any drug-related AE leading to discontinuation of anti-TB agents (seven patients were unable to resume treatment with anti-TB agents before death) (aOR 2.29, 95% CI 1.02–5.11).ConclusionsIn-hospital AEs (i.e. health-care-associated infection and drug-related AEs), as well as patient-related variables, were associated with in-hospital mortality among TB patients.     

Age at menarche in Iran

BACKGROUND: Age at menarche and its potential associated factors are reported for 1862 Shiraz (Southern Iran) secondary school girls taking part in a cross-sectional survey selected from the four educational districts of the city. METHODS: Probit analysis was used to estimate age at menarche, principal component analysis (PCA) was applied to analyse socio-economic status (SES). Body mass index (BMI) was used as an indicator of nutrition. RESULTS: Mean +/- SD age at menarche was 12.91 +/- 1.23 years (95% CI: 12.84-12.97). Of all subjects, 33.7% first menstruated in summer. The highest mean age at menarche was 13.01 years in winter. Stress, anxiety and discomfort was seen among 70.3% of subjects at menarche indicating total or partial ignorance of the menstruation phenomenon. Age at menarche decreased as SES improved. Menarcheal age was delayed for underweight subjects. CONCLUSIONS: It is concluded that BMI and SES had the most significant effects on variation of menarcheal age in a unified statistical model. However, their interaction was found to be not statistically significant.     

Tuberculosis incidence and mortality in people living with human immunodeficiency virus: a Danish nationwide cohort study

ObjectivesTo explore changes over time in the epidemiology of tuberculosis (TB) in Denmark in people living with human immunodeficiency virus (HIV) (PLWH).MethodsIn this nationwide, population-based cohort study we included all adult PLWH from the Danish HIV Cohort Study (1995–2017) without previous TB. We estimated TB incidence rate (IR), all-cause mortality rate (MR), associated risk and prognostic factors using Poisson regression.ResultsAmong 6982 PLWH (73 596 person-years (PY)), we observed 217 TB events (IR 2.9/1000 PY, 95% CI 2.6–3.4: IR 6.7, 95% CI 5.7–7.9 among migrants and IR 1.4, 95% CI 1.1–1.7 among Danish-born individuals; p < 0.001). The IR of concomitant HIV/TB remained high and unchanged over time. The IR of TB diagnosed >3 months after HIV diagnosis declined with calendar time, longer time from HIV diagnosis, and CD4 cell recovery. Independent TB risk factors were African/Asian/Greenland origin (adjusted incidence rate ratio (aIRR) 5.2, 95% CI 3.5–7.6, aIRR 6.5, 95% CI 4.2–10.0, aIRR 7.0, 95% CI 3.4–14.6, respectively), illicit drug use (aIRR 6.9, 95% CI 4.2–11.2), CD4 <200 cells/μL (aIRR 2.7, 95% CI 2.0–3.6) and not receiving antiretroviral therapy (aIRR 3.7, 95% CI 2.5–5.3). Fifty-five patients died (MR 27.9/1000 PY, 95% CI 21.4–36.3), with no improvement in mortality over time. Mortality prognostic factors were Danish-origin (adjusted mortality rate ratio (aMRR) 2.3, 95% CI 1.3–4.3), social burden (aMRR 3.9, 95% CI 2.2–7.0), CD4 <100 cells/μL at TB diagnosis (aMRR 2.6, 95% CI 1.3–4.9), TB diagnosed >3 months after HIV versus concomitant diagnosis (aMRR 4.3, 95% CI 2.2–8.7) and disseminated TB (aMRR 3.3, 95% CI 1.1–9.9).ConclusionLate HIV presentation with concomitant TB remains a challenge. Declining TB rates in PLWH were observed over time and with CD4 recovery, highlighting the importance of early and successful antiretroviral therapy. However, MR remained high. Our findings highlight the importance of HIV and TB screening strategies and treatment of latent TB in high-risk groups.