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Tuberculosis Burden and Determinants of Treatment Outcomes According to Age in Brazil: A Nationwide Ecological Study of 896,314 Cases Reported between 2010 and 2019

24 Pages Posted: 15 Mar 2021

See all articles by Beatriz Barreto Duarte

Beatriz Barreto Duarte

Oswaldo Cruz Foundation (FIOCRUZ) - Laboratório de Inflamação e Biomarcadores

Mariana Araújo-Pereira

Oswaldo Cruz Foundation (FIOCRUZ) - Laboratório de Inflamação e Biomarcadores; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative

Betania M. F. Nogueira

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative

Luciana Sobral

Escola Bahiana de Medicina e Saúde Pública

Moreno M. S. Rodrigues

Oswaldo Cruz Foundation (FIOCRUZ) - Laboratório de Análise e Visualização de Dados

Artur T. L. Queiroz

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative

Michael S. Rocha

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative

Vanessa Nascimento

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative

Alexandra Brito Souza

Universidade do Estado do Amazonas - Programa de Pós-Graduação em Medicina Tropical

Marcelo Cordeiro-Santos

Universidade do Estado do Amazonas - Programa de Pós-Graduação em Medicina Tropical

Afranio L. Kritski

Universidade Federal do Rio de Janeiro (UFRJ) - Programa Acadêmico de Tuberculose

Timothy R. Sterling

Vanderbilt University - Division of Infectious Diseases

María B. Arriaga

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative; Oswaldo Cruz Foundation (FIOCRUZ) - Laboratório de Inflamação e Biomarcadores

Bruno B. Andrade

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative; Oswaldo Cruz Foundation (FIOCRUZ) - Laboratório de Inflamação e Biomarcadores

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Abstract

Background: Approximately 1·4 million people die annually worldwide from tuberculosis. Large epidemiologic studies can identify determinants of unfavorable clinical outcomes according to age, which can guide implementation of public health policies and clinical management to improve outcomes.

Methods: We obtained data from the national tuberculosis case registry: cases reported to the Brazilian National Program (SINAN) between 2010-2019. Clinical and epidemiologic variables were compared between age groups (child:<10 years, young:10-24years, adult:25-64years and elderly:≥65years). Univariate comparisons were performed together with second-generation p-values. We applied a backward stepwise multivariable logistic regression model to identify characteristics in each age group associated with unfavorable TB treatment outcomes.

Findings: There were 896,314 tuberculosis cases reported during the period. The tuberculosis incidence was highest among adult males, but the young males presented the highest growth rate between the period. Directly observed therapy (DOT) was associated with protection against unfavorable outcomes in all age groups. The use of alcohol, illicit drugs, and smoking, as well as occurrence of comorbidities were significantly different between age groups. Lack of DOT, previous tuberculosis, race, location of tuberculosis disease, and HIV infection were independent risk factors for unfavorable outcome depending on the age group. 

Interpretation: The clinical and epidemiological risk factors for unfavorable tuberculosis treatment outcomes varied according to age in Brazil. DOT was associated with improved outcomes in all age groups. Incidence according to the age and sex identified adults and young males as the groups that need prevention efforts. This supports implementation of DOT in all population to improve tuberculosis outcomes. ​

Funding Statement: This study was supported by the National Institutes of Health (NIH U01 AI069923 and NIAID 1 P30AI110527-03), CCASAnet, RePORT-Brazil Tennessee Center for AIDS Research (TNCFAR), BB-D and MA-P received a research fellowship from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) (Finance code: 001). MBA received a fellowship from the Fundação de Amparo à Pesquisa da Bahia (FAPESB). The work of BBA is supported by the Intramural Research Program of the Oswaldo Cruz Foundation (FIOCRUZ) and the National Council for Scientific and Technological Development (CNPq), Brazil.

Declaration of Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Keywords: tuberculosis, age, outcomes, pulmonary TB, extrapulmonary TB

Suggested Citation

Barreto Duarte, Beatriz and Araújo-Pereira, Mariana and Nogueira, Betania M. F. and Sobral, Luciana and Rodrigues, Moreno M. S. and Queiroz, Artur T. L. and Rocha, Michael S. and Nascimento, Vanessa and Souza, Alexandra Brito and Cordeiro-Santos, Marcelo and Kritski, Afranio L. and Sterling, Timothy R. and Arriaga, María B. and Andrade, Bruno B., Tuberculosis Burden and Determinants of Treatment Outcomes According to Age in Brazil: A Nationwide Ecological Study of 896,314 Cases Reported between 2010 and 2019. Available at SSRN: https://ssrn.com/abstract=3800005 or http://dx.doi.org/10.2139/ssrn.3800005

Beatriz Barreto Duarte

Oswaldo Cruz Foundation (FIOCRUZ) - Laboratório de Inflamação e Biomarcadores ( email )

Salvador
Brazil

Mariana Araújo-Pereira

Oswaldo Cruz Foundation (FIOCRUZ) - Laboratório de Inflamação e Biomarcadores ( email )

Salvador
Brazil

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative ( email )

Betania M. F. Nogueira

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative ( email )

Salvador
Brazil

Luciana Sobral

Escola Bahiana de Medicina e Saúde Pública ( email )

BA
Brazil

Moreno M. S. Rodrigues

Oswaldo Cruz Foundation (FIOCRUZ) - Laboratório de Análise e Visualização de Dados ( email )

Rio de Janeiro
Brazil

Artur T. L. Queiroz

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative ( email )

Salvador
Brazil

Michael S. Rocha

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative ( email )

Salvador
Brazil

Vanessa Nascimento

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative

Salvador
Brazil

Alexandra Brito Souza

Universidade do Estado do Amazonas - Programa de Pós-Graduação em Medicina Tropical ( email )

Avenida Djalma Batista, 3578
Manaus, 69050-010
Brazil

Marcelo Cordeiro-Santos

Universidade do Estado do Amazonas - Programa de Pós-Graduação em Medicina Tropical ( email )

Avenida Djalma Batista, 3578
Manaus, 69050-010
Brazil

Afranio L. Kritski

Universidade Federal do Rio de Janeiro (UFRJ) - Programa Acadêmico de Tuberculose ( email )

Rua Tonelero, 380 apt. 804
Copacabana, 22030-000
Brazil

Timothy R. Sterling

Vanderbilt University - Division of Infectious Diseases ( email )

United States

María B. Arriaga

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative ( email )

Oswaldo Cruz Foundation (FIOCRUZ) - Laboratório de Inflamação e Biomarcadores ( email )

Salvador
Brazil

Bruno B. Andrade (Contact Author)

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative ( email )

Oswaldo Cruz Foundation (FIOCRUZ) - Laboratório de Inflamação e Biomarcadores ( email )

Salvador
Brazil