Trends in tuberculosis mortality in Brazil (1990-2015): joinpoint analysis

Souza, Carlos Dornels Freire de; Paiva, João Paulo Silva de; Silva, Leonardo Feitosa da; Leal, Thiago Cavalcanti; Magalhães, Mônica de Avelar Figueiredo Mafra

doi:10.1590/1806-3713/e20180393

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Jornal Brasileiro de Pneumologia

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BRIEF COMMUNICATION • J. bras. pneumol. 45 (02) • 2019 • https://doi.org/10.1590/1806-3713/e20180393 copy

Trends in tuberculosis mortality in Brazil (1990-2015): joinpoint analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The objective of this study was to analyze trends in the tuberculosis mortality rate in Brazil (1990-2015) in an ecological time-series analysis. The indicators were obtained from the Brazilian National Ministry of Health. A joinpoint regression model was applied for the temporal analysis, with a level of significance of 5%. During the period in question, there was a trend toward a reduction in mortality in the country as a whole (p < 0.001) and in each of its five regions. The states with the highest tuberculosis mortality rates were Rio de Janeiro (7.0/100,000 population) and Pernambuco (5.0/100,000 population). Eleven states and the Federal District of Brasília showed downward trends. Only the state of Alagoas showed a significant increase (p < 0.001). The temporal behavior observed indicates that tuberculosis continues to be a major public health problem in Brazil.

Keywords:
Tuberculosis/epidemiology; Tuberculosis/mortality; Mortality/trends; Epidemiologic studies

Region/state	Mortality/100,000 population			Period	APC (95% CI)	AAPC (95% CI)
Region/state	1990	2015	1990 to 2015
BRAZIL	3.6	2.3		1990-1998	0.5 (-0.3 to 1.3)	-1.9* (-2.4 to -1.4)
			3.0	1998-2003	-5.8* (-8.0 to -3.6)
				2003-2015	-1.9* (-2.3 to -1.4)
North	3.1	2.3	2.6	1990-2015	-1.0* (-1.3 to -0.6)	-1.0* (-1.3 to -0.6)
RO	4.4	1.4	2.5	1990-2015	-4.1* (-4.9 to -3.4)	-4.1* (-4.9 to -3.4)
AC	3.7	2.2	3.6	1990-2015	-3.7* (-5.1 to -2.3)	-3.7* (-5.1 to -2.3)
AM	3.8	3.3	3.5	1990-2015	-0.4 (-0.9 to 0.1)	-0.4 (-0.9 to 0.1)
RR	3.9	0.8	2.5	1990-2015	-9.2* (-14.4 to -3.8)	-9.2* (-14.4 to -3.8)
PA	3.0	2.6	2.5	1990-1996	-6.0* (-10.0 to -1.7)	-0.6 (-1.7 to 0.5)
PA	3.0	2.6	2.5	1996-2015	1.1* (0.4 to 1.9)	-0.6 (-1.7 to 0.5)
AP	2.5	1.8	1.9	1990-2015	-1.8* (-3.1 to -0.4)	-1.8* (-3.1 to -0.4)
TO	0.3	0.5	1.1	1990-1992	126.2 (-25.3 to 585.3)	4.4 (-4.3 to 13.8)
TO	0.3	0.5	1.1	1992-2015	-2.4 (-4.8 to 0.0)	4.4 (-4.3 to 13.8)
Northeast	3.0	2.7	3.0	1990-1998	1.5* (0.3 to 2.7)	-0.5* (-0.9 to -0.01)
Northeast	3.0	2.7	3.0	1998-2015	-1.3* (-1.7 to -1.0)	-0.5* (-0.9 to -0.01)
MA	1.9	2.2	2.3	1990-2009	3.1* (1.9 to 4.4)	1.1 (-0.7 to 2.9)
MA	1.9	2.2	2.3	2009-2015	-5.1 (-11.5 to 1.8)	1.1 (-0.7 to 2.9)
PI	2.6	1.4	2.1	1990-1996	-10.1* (-17.9 to -1.5)	-1.1 (-7.4 to 5.5)
				1996-1999	27.3 (-25.9 to 118.6)
				1999-2015	-2.3* (-4.3 to -0.2)
CE	2.0	2.3	2.8	1990-1992	31.5 (-5.8 to 83.6)	1.0 (-4.7 to 7.0)
				1992-1995	-13.5 (-38.0 to 20.8)
				1995-1998	17.9 (-15.5 to 64.6)
				1998-2015	-2.1* (-3.3 to -1.0)
RN	2.0	1.9	2.2	1990-2015	-1.0 (-2.2 to 0.3)	-1.0 (-2.2 to 0.3)
PB	1.7	2.2	2.0	1990-2015	1.1 (-0.2 to 2.5)	1.1 (-0.2 to 2.5)
PE	4.8	4.5	5.0	1990-1998	2.6* (0.7 to 4.4)	-0.3 (-1.7 to 1.1)
				1998-2013	-3.0* (-3.7 to -2.2)
				2013-2015	9.1 (-7.4 to 28.6)
AL	2.5	2.3	2.7	1990-2015	1.0* (0.2 to 1.8)	1.0* (0.2 to 1.8)
SE	2.3	2.0	2.0	1990-2015	0.0 (-0.8 to 0.9)	0.0 (-0.8 to 0.9)
BA	3.8	2.7	3.2	1990-2015	-1.6* (-1.9 - -1.2)	-1.6* (-1.9 to -1.2)
Southeast	4.6	2.4	3.5	1990-1997	1.0 (-0.0 to 2.1)	-2.7* (-3.1 to -2.2)
				1997-2005	-6.9* (-7.9 to -5.9)
				2005-2015	-1.7* (-2.3 to -1.1)
MG	2.4	1.1	1.8	1990-2011	-2.5* (-3.0 to -2.1)	-3.3* (-4.2 to -2.4)
MG	2.4	1.1	1.8	2011-2015	-7.2* (-12.3 to -1.8)	-3.3* (-4.2 to -2.4)
ES	2.3	1.9	2.4	1990-1993	11.1 (-2.9 to 27.1)	-0.9 (-2.7 to 1.0)
				1993-2005	-5.3* (-7.0 to -3.6)
				2005-2015	1.1 (-1.0 to 3.3)
RJ	9.1	5.0	7.0	1990-1995	3.2 (-0.01 to 6.5)	-2.1* (-2.9 to -1.3)
				1995-2005	-6.1* (-7.3 to -4.9)
				2005-2015	-0.6 ( -1.7 to 0.5)
SP	4.1	2.0	3.2	1990-1999	0.8 (-0.1 to 1.7)	-3.0* (-3.6 to -2.4)
				1999-2005	-10.3* (-12.2 to -8.3)
				2005-2015	-1.8* (-2.6 to -1.1)
South	2.5	1.6	2.2	1990-1994	4.8 (-0.6 to 10.5)	-1.8* (-3.3 to -0.3)
				1994-2013	-4.0* (-4.6 to -3.5)
				2013-2015	7.7 (-8.9 to 27.4)
PR	2.0	1.1	1.9	1990-1998	3.8* (0.9 to 6.7)	-2.5* (-4.2 to -0.7)
				1998-2012	-7.0* (-8.3 to -5.8)
				2012-2015	3.6 (-8.9 to 17.9)
SC	1.1	0.8	1.1	1990-2015	-2.1* (-2.8 to -1.3)	-2.1* (-2.8 to -1.3)
RS	3.6	2.6	3.0	1990-1993	4.8 (-3.1 to 13.3)	-1.3 (-3.7 to 1.2)
				1993-2006	-4.1* (-5.0 to -3.2)
				2006-2009	2.7 (-12.2 to 20.2)
				2009-2013	-6.4 (-13.4 to 1.3)
				2013-2015	13.9 (-2.6 to 33.2)
Central-West	1.6	1.4	1.8	1990-1998	2.7* (0.2 to 5.2)	-1.3* (-2.2 to -0.4)
Central-West	1.6	1.4	1.8	1998-2015	-3.1* (-3.9 to -2.4)	-1.3* (-2.2 to -0.4)
MS	2.4	1.8	2.8	1990-2015	-1.3* (-2.2 to -0.3)	-1.3* (-2.2 to -0.3)
MT	2.2	2.2	3.0	1990-1998	7.0* (2.7 to 11.4)	-0.4 (-1.9 to 1.0)
MT	2.2	2.2	3.0	1998-2015	-3.8* (-5.0 to -2.5)	-0.4 (-1.9 to 1.0)
GO	0.9	1.1	1.2	1990-1993	16.9 (-2.3 to 39.8)	0.1 (-2.0 to 2.3)
GO	0.9	1.1	1.2	1993-2015	-2.0* (-2.8 to -1.1)	0.1 (-2.0 to 2.3)
DF	1.9	0.5	1.0	1990-2015	-5.9* (-7.5 to -4.3)	-5.9* (-7.5 to -4.3)

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E-mail: jbp@sbpt.org.br

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[1] Correspondence to:
Carlos Dornels Freire de Souza. Universidade Federal de Alagoas, Avenida Manoel Severino Barbosa, s/n, Bom Sucesso, CEP 57309-005, Arapiraca, AL, Brasil. Tel.: 55 87 99622-0698. E-mail: carlos.freire@arapiraca.ufal.br