{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T10:52:12Z","timestamp":1791975132457,"version":"4.4.0"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":86,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pulm Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Japan had long been a medium-burden country for tuberculosis (TB) but became a low-burden country in 2021. Shizuoka Prefecture is geographically located in Central Japan, and the incidence rate of TB is also at the average level in Japan.<\/jats:p>\n                    <jats:p>This study aimed to understand TB patients' characteristics and risk factors by analyzing the data from 2009 to 2020 in Shizuoka Prefecture, a representative sample for Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively collected 1,132 patients with smear-positive pulmonary TB who were admitted to Shimada General Medical Center or Shizuoka General Hospital in the central area of Shizuoka Prefecture from 2009 to 2020. Patients were divided into alive and dead (i.e., all-cause in-hospital death during anti-tuberculosis treatment) groups, and clinical parameters were compared between the two groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median age of all patients was 80. The number of patients decreased from 2009 to 2020. Moreover, the number of patients over 70 gradually reduced, which was similar for all patients. Immigrant TB patients were 5% of all patients, which was very small compared to the total number of patients. Almost all were from Southeast Asian countries. In multivariate analysis, older age, low body mass index, respiratory failure, low serum albumin, lymphocyte, high serum creatinine levels, and neutrophil were independent prognostic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The decline in TB among elderly patients, who comprise most of the population, might be one reason why Japan has become a low-burden country. Although the rate of immigrants is minimal, caution is needed about the increase, especially from Southeast Asian countries. There is a need for a TB medical system that can deal with complications and malnutrition, which are risk factors for death.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12890-026-04521-7","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T03:05:01Z","timestamp":1784516701000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Characteristics and risk factors for mortality among hospitalized patients with pulmonary tuberculosis in Shizuoka Prefecture in 2009\u20132020"],"prefix":"10.1186","volume":"26","author":[{"given":"Kei","family":"Kanata","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshihiro","family":"Shirai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaro","family":"Kishimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taisuke","family":"Akamatsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaro","family":"Ito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koshiro","family":"Ichijo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Uehara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"4521_CR1","unstructured":"World Health Organization. Global Tuberculosis Report 2022. Geneva: World Health Organization. 2022. Available from: https:\/\/www.who.int\/teams\/global-tuberculosis-programme\/tbreports\/global-tuberculosis-report-2022."},{"key":"4521_CR2","unstructured":"National Public Health Service - Northern Region. National Public Health Service website. Available from: https:\/\/www.arphs.health.nz\/public-health-topics\/immunisation\/countries-with-a-high-incidence-of-tb\/."},{"key":"4521_CR3","unstructured":"Kawatsu L, Kasuya S, Imai A, Yoshie A, Uchimura K. Tuberculosis in Japan: Annual Report 2022. Tokyo: Research Institute of Tuberculosis\/JATA; 2022."},{"key":"4521_CR4","doi-asserted-by":"publisher","unstructured":"Hagiya H, Koyama T, Zamami Y, Minato Y, Tatebe Y, Mikami N, et al. Trends in incidence and mortality of tuberculosis in Japan: a population-based study, 1997\u20132016. Epidemiol Infect. 2018;147. https:\/\/doi.org\/10.1017\/S095026881800290X.","DOI":"10.1017\/S095026881800290X"},{"key":"4521_CR5","unstructured":"Research Institute of Tuberculosis\/JATA. TB Control Program in Japan. Available from: https:\/\/jata.or.jp\/Department_of_International_Cooperation\/TB_Control_in_Japan.html."},{"key":"4521_CR6","doi-asserted-by":"publisher","unstructured":"Ota M, Nishimura T, Uchimura K, Hirao S. Epidemiology of tuberculosis in foreign students in Japan, 2015\u20132019: a comparison with the notification rates in their countries of origin. Epidemiol Infect. 2021;149e202. https:\/\/doi.org\/10.1017\/S0950268821001977.","DOI":"10.1017\/S0950268821001977"},{"key":"4521_CR7","unstructured":"The Tuberculosis Surveillance Center. Number of newly registered tuberculosis cases (rate) by prefecture\/city. Available from: https:\/\/jata-ekigaku.jp\/archive."},{"key":"4521_CR8","unstructured":"World Health Organization. Global tuberculosis report 2016. Geneva: WHO; 2016. Available from: http:\/\/apps.who.int\/."},{"key":"4521_CR9","unstructured":"van den Hof S, Najlis CA, Bloss E, Straetemans M. A systematic review on the role of gender in tuberculosis control. The Hague: KNCV Tuberculosis Foundation; 2010. Available from https:\/\/www.kncvtbc.org\/uploaded\/2015\/09\/Role_of_Gender_in_TB_Control.pdf."},{"issue":"11","key":"4521_CR10","first-page":"1336","volume":"12","author":"F Karim","year":"2008","unstructured":"Karim F, Ahmed F, Begum I, Johansson E, Diwan VK. Female-male differences at various clinical steps of tuberculosis management in rural Bangladesh. Int J Tuberc Lung Dis. 2008;12(11):1336\u20139.","journal-title":"Int J Tuberc Lung Dis"},{"issue":"4","key":"4521_CR11","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1136\/thx.2005.049452","volume":"61","author":"ME Jim\u00e9nez-Corona","year":"2006","unstructured":"Jim\u00e9nez-Corona ME, Garc\u00eda-Garc\u00eda L, DeRiemer K, Ferreyra-Reyes L, Bobadilla-del-Valle M, Cano-Arellano B, et al. Gender differentials of pulmonary tuberculosis transmission and reactivation in an endemic area. Thorax. 2006;61(4):348\u201353.","journal-title":"Thorax"},{"issue":"9859","key":"4521_CR12","doi-asserted-by":"publisher","first-page":"2224","DOI":"10.1016\/S0140-6736(12)61766-8","volume":"380","author":"SS Lim","year":"2012","unstructured":"Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990\u20132010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224\u201360.","journal-title":"Lancet"},{"issue":"4","key":"4521_CR13","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1111\/j.1469-0691.2012.03931.x","volume":"18","author":"JY Feng","year":"2012","unstructured":"Feng JY, Huang SF, Ting WY, Chen YC, Lin YY, Huang RM, et al. Gender differences in treatment outcomes of tuberculosis patients in Taiwan: a prospective observational study. Clin Microbiol Infect. 2012;18(4):331\u20137.","journal-title":"Clin Microbiol Infect"},{"issue":"6","key":"4521_CR14","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1136\/jech-2014-204292","volume":"69","author":"GS Smith","year":"2015","unstructured":"Smith GS, Van Den Eeden SK, Baxter R, Shan J, Van Rie A, Herring AH, et al. Cigarette smoking and pulmonary tuberculosis in northern California. J Epidemiol Community Health. 2015;69(6):568\u201373.","journal-title":"J Epidemiol Community Health"},{"issue":"3","key":"4521_CR15","doi-asserted-by":"publisher","first-page":"e24","DOI":"10.1016\/j.jinf.2020.07.004","volume":"81","author":"K Komiya","year":"2020","unstructured":"Komiya K, Yamasue M, Takahashi O, Hiramatsu K, Kadota K, Kato S. The COVID-19 pandemic and the true incidence of Tuberculosis in Japan. J Infect. 2020;81(3):e24\u20135.","journal-title":"J Infect"},{"key":"4521_CR16","unstructured":"Ikegami S. The increase in the number of immigrants to Japan mainly focused on the Brazilians living in Hamamatsu city in Shizuoka Prefecture. Hamamatsu; 2005."},{"issue":"2","key":"4521_CR17","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/j.chest.2023.09.123","volume":"165","author":"T Osawa","year":"2024","unstructured":"Osawa T, Watanabe M, Morimoto K, Yoshiyama T, Matsuda S, Fujiwara K, et al. Activities of Daily Living, Hypoxemia, and Lymphocytes Score for Predicting Mortality Risk in Patients With Pulmonary TB. Chest. 2024;165(2):267\u201377. https:\/\/doi.org\/10.1016\/j.chest.2023.09.123.","journal-title":"Chest"}],"container-title":["BMC Pulmonary Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12890-026-04521-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-026-04521-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-026-04521-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T10:26:58Z","timestamp":1791973618000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12890-026-04521-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,20]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4521"],"URL":"https:\/\/doi.org\/10.1186\/s12890-026-04521-7","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-5190034\/v1","asserted-by":"object"}]},"ISSN":["1471-2466"],"issn-type":[{"value":"1471-2466","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,20]]},"assertion":[{"value":"2 October 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The present study was conducted with the approval of the research ethics committee at Shimada General Medical Center (Approval number: R 6\u2009\u2212\u20095).","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"469"}}