Tuberculosis fatality rates in the city of Campinas - São Paulo, Brazil, from 2001 to 2009

Oliveira, Helenice Bosco de; Marin-Léon, Letícia; Saita, Nanci Michele; Golub, Jonathan Eric

doi:10.1590/1980-549720190043

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 22 • 2019 • https://doi.org/10.1590/1980-549720190043 copy

Tuberculosis fatality rates in the city of Campinas - São Paulo, Brazil, from 2001 to 2009

Taxas de letalidade por tuberculose na cidade de Campinas, São Paulo, Brasil, de 2001 a 2009

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Introduction:

The mortality rate among tuberculosis patients (TB fatality) has been attributed to irregular chemotherapy, delay in diagnosis, multidrug resistance, and HIV coinfection.

Objective:

To analyze TB fatality rates by sex, clinical presentation and HIV coinfection in Campinas, São Paulo, Brazil.

Methods:

Cohorts of residents in the city of Campinas who either died during treatment for tuberculosis or had the disease confirmed after death were divided into three intervals: 2001-2003, 2004-2006, and 2007-2009. Data were obtained from the database of the Tuberculosis Surveillance System of the University of Campinas, and notifications were gathered through TB-WEB Health São Paulo Secretary. Statistical significance was determined using a chi-square test, considering p < 0.05.

Results:

Between 2001 and 2009, 3,416 TB patients were diagnosed: 2,827 (82.8%) were new TB cases and 589 (17.2%) were retreatments. Between the first and second triennium, the number of new patients decreased by 18%, and 23% among retreatments. Between the second and third intervals, the reduction was 5% and 21%, respectively. General case fatality rate declined from 11.4% to 9.9% across intervals, and was most significant among patients that had previously abandoned treatment (17.3% to 5.1%). Fatality rates among patients coinfected with TB-AIDS were 2-3 times that of patients not infected with TB-AIDS throughout the intervals. Fatality between the first and third triennium among TB-AIDS co-infected patients declined (24.8% to 19.5%), while increasing slightly among non-AIDS TB patients (7.3% to 8%) during this period.

Conclusion:

Though mortality among TB-AIDS patients declined from 2001-2009, rates among non-AIDS TB remained stagnant. Improved TB diagnosis and treatment is needed to further decrease TB mortality in Campinas.

Keywords:
Tuberculosis; AIDS; Case fatality rate; Comorbidity; Treatment; Mortality

Variables	2001-2003		2004-2006		2007-2009		p-value
Variables	n	%	n	%	n	%	p-value
Entrance
New case	1088	81.4	891	82.4	848	84.9	0.087
Relapse	111	8.3	92	8.5	69	6.9	0.336
Previous dropout	133	10.0	95	8.8	79	7.9	0.198
Failure	4	0.3	3	0.3	3	0.3	0.994
Total number of cases	1336	100	1081	100	999	100
Deaths
New case	116	76.3	94	81.0	86	86.9	0.117
Relapse	13	8.6	14	12.1	8	8.1	0.528
Previous dropout	23	15.1	8	6.9	4	4.0	0.007
Failure	0	0	0	0	1	1.0	-
Total number of deaths	152	100	116	100	99	100
Fatality rate
New case	10.7		10.5		10.1		0.929
Relapse	11.7		15.2		11.6		0.701
Previous dropout	17.3		8.4		5.1		0.014
Failure	-		-		33.3		-
General	11.4		10.7		9.9		0.526

Variables	2001-2003		2004-2006		2007-2009		p-value
Variables	n	%	n	%	n	%	p-value
TB-AIDS
Patients (N = 687)
Female	80	25.7	61	29.5	55	32.5	0.269
Male	231	74.3	146	70.5	114	67.5	0.269
Total	311	100	207	100	169	100
Deaths (N = 160)
Female	17	22.1	19	38.0	11	33.3	0.134
Male	60	77.9	31	62.0	22	66.7	0.134
Total	77	100	50	100	33	100
Fatality rate
Female	21.3		31.1		20.0		0.283
Male	26.0		21.2		19.3		0.318
Total	24.8		24.2		19.5		0.406
non-AIDS TB
Patients (N = 2,729)
Female	348	33.9	285	32.6	251	30.2	0.250
Male	677	66.1	589	67.4	579	69.8	0.250
Total	1,025	100	874	100	830	100
Deaths (N = 207)
Female	19	25.3	18	27.3	11	16.7	0.303
Male	56	74.7	48	72.7	55	83.3	0.303
Total	75	100	66	100	66	100
Fatality rate
Female	5.5		6.3		4.4		0.615
Male	8.3		8.2		9.5		0.658
Total	7.3		7.6		8.0		0.876

Variables	2001-2003		2004-2006		2007-2009		p-value
Variables	n	%	n	%	n	%	p-value
I. New cases
Pulmonary presentation
Patients
TB-AIDS	176	18.9	92	12.5	97	13.5	< 0.001
non-AIDS TB	757	81.1	642	87.5	624	86.5
Total	933	100	734	100	721	100
Deaths
TB-AIDS	43	44.8	22	31.0	16	22.9	0.010
non-AIDS TB	53	55.2	49	69.0	54	77.1
Total	96	100	71	100	70	100
Fatality rate
TB-AIDS	24.4		23.9		16.5		0.288
non-AIDS TB	7.0		7.6		8.7		0.517
Total	10.3		9.7		9.7		0.892
Extra-pulmonary presentation
Patients
TB-AIDS	51	32.9	39	24.8	33	26.0	0.237
non-AIDS TB	104	67.1	118	75.2	94	74.0
Total	155	100	157	100	127	100
Deaths
TB-AIDS	9	45.0	13	56.5	9	56.2	0.708
non-AIDS TB	11	55.0	10	43.5	7	43.8
Total	20	100	23	100	16	100
Fatality rate
TB-AIDS	17.6		33.3		27.3		0.225
non-AIDS TB	10.6		8.5		7.5		0.728
Total	12.9		14.7		12.6		0.855
II. Retreatment
Pulmonary presentation
Patients
TB-AIDS	69	31.5	62	36.7	32	23.0	0.035
non-AIDS TB	150	68.5	107	63.3	107	77.0
Total	219	100	169	100	139	100
Deaths
TB-AIDS	22	66.7	12	63.2	8	61.5	0.936
non-AIDS TB	11	33.3	7	36.8	5	38.5
Total	33	100	19	100	13	100
Fatality rate
TB-AIDS	31.9		19.4		25.0		0.260
non-AIDS TB	7.3		6.5		4.7		0.684
Total	15.1		11.2		9.4		0.241
Extra-pulmonary presentation
Patients
TB-AIDS	15	51.7	14	66.7	7	58.3	0.572
non-AIDS TB	14	48.3	7	33.3	5	41.7
Total	29	100	21	100	12	100
Deaths
TB-AIDS	3	100	3	100	0	-	-
non-AIDS TB	0	-	0	-	0	-	-
Total	3	100	3	100	0	-	-
Fatality rate
TB-AIDS	20.0		21.4		-		0.417
non-AIDS TB	-		-		-		-
Total	10.3		14.3		-		0.404

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[1] Corresponding author: Helenice Bosco de Oliveira. Rua Waldyr Aparecido da Silva, 60, Residencial II, Condomínio Barão do Café, Barão Geraldo, CEP: 13085-065, Campinas, SP, Brazil. E-mail: helenice@unicamp.br