From Pandemic to Endemic: Assessing the Impact of COVID-19 History and Socio-Demographic Factors on Quality of Life in Tuberculosis Patients

Denisa Maria Mitroi¹Mara Amalia BĂLTEANU²Ovidiu Zlatian^3*Claudia Lucia Toma^4*Oana Maria Catana¹Adina Andreea Mirea⁵Georgiana Camen⁶Viorel Biciusca^7,8RAMONA CIOBOATA^7,9

• ¹Doctoral School, University of Medicine and Pharmacy of Craiova, Craiova, Romania
• ²Department of Pulmonology, Faculty of Medicine, Titu Maiorescu University, Craiova, Romania
• ³University of Medicine and Pharmacy of Craiova, Craiova, Romania
• ⁴Pneumology, Carol Davila University of Medicine and Pharmacy, Bucharest, Bucharest, Romania
• ⁵Oral-Dental Prevention, University of Medicine and Pharmacy of Craiova, Craiova, Dolj, Romania
• ⁶Radiology, University of Medicine and Pharmacy of Craiova, Craiova, Dolj, Romania
• ⁷Pneumology, University of Medicine and Pharmacy of Craiova, Craiova, Dolj, Romania
• ⁸Internal Medicine, Filantropia Hospital, Craiova, Romania
• ⁹Victor Babes Infectious Diseases and Pneumology Hospital, Craiova, Romania

Background: Tuberculosis (TB) and COVID-19 are major global health concerns, and their interaction, particularly regarding socio-demographic factors, remains insufficiently explored. This study assessed the impact of prior confirmed COVID -19, alongside age, education, smoking, gender, and marital status, on TB relapse risk and quality of life (QOL) among TB patients in South-Western Romania. Methods: A cross-sectional analysis was performed on 763 bacteriologically confirmed TB patients enrolled between October 2022 and January 2025. Participants provided socio-demographic and clinical information and completed the WHOQOL-BREF questionnaire. Binary logistic regression was used to identify predictors of TB relapse, while structural equation modelling (SEM) assessed factors influencing QOL.Results: Patients with a confirmed history of COVID-19 exhibited a twofold increase in TB relapse risk (OR=2.08, p=0.003). Age was a strong predictor, with individuals aged 36-60 years and those >60 years showing over fivefold (OR=5.08, p<0.001) and nearly fourfold (OR=3.96, p=0.004) increases in relapse risk, respectively. Smoking further increased relapse odds by 76% (OR=1.77, p=0.009). Conversely, secondary and tertiary education significantly reduced relapse risk (OR=0.48, p=0.002; OR=0.46, p=0.006). SEM revealed that COVID-19 history had a pronounced negative impact on QOL (β=-0.51, p<0.001), while marital status (β≈0.09, p=0.022) and education (β≈0.18, p<0.001) were positively associated with QOL.COVID-19, advanced age, and smoking significantly elevate TB relapse risk and detrimentally affect QOL, whereas higher education appears protective. Integrated interventions addressing COVID-19 prevention, smoking cessation, and socio-economic support are essential to improve TB outcomes and patient quality of life.