Factors associated with deaths by tuberculosis in the state of Mato Grosso, 2011-2020: retrospective cohort study

Lopes, Vanessa da Silva; Couto, Rodrigo de Macedo; Luz, Alexandre Peron da; Silva, Pãmela Rodrigues de Souza; Lima, Jaqueline Costa

doi:10.1590/S2237-96222024V33E20231402.EN

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 33 • 2024 • https://doi.org/10.1590/S2237-96222024V33E20231402.EN linkcopy

Factors associated with deaths by tuberculosis in the state of Mato Grosso, 2011-2020: retrospective cohort study

Factores asociados a las muertes por tuberculosis en el estado de Mato Grosso, 2011-2020: estudio de cohorte retrospectivo

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective: To investigate factors associated with tuberculosis deaths in Mato Grosso state, Brazil, from 2011 to 2020.

Methods: Retrospective cohort study with data obtained from the Notifiable Health Conditions Information System and the Mortality Information System. Deaths were qualified using probabilistic linkage and analyzed using Poisson regression.

Results: 12,331 cases and 525 deaths were identified over 10 years. The factors associated with death were: age ≥60 years (RR: 7.70; 95%CI 1.91;31.04), incomplete elementary and high school education (RR: 3.66; 95%CI 1.34;9.96), illiteracy (RR: 4.50; 95%CI 1.60;12.66), homeless population (RR: 2.41; 95%CI 1.34;4.35), alcohol use (RR: 1.45; 95%CI 1.04;2.02), male sex (RR: 1.48; 95%CI 1.04;2.09) and tobacco use (RR: 1.32; 95%CI 0.98;1.77). Laboratory confirmation was a protective factor.

Conclusion: Risk of death was higher in men over 60 years old, with low education levels, in vulnerable situations, and who used alcohol/tobacco.

Keywords:
Tuberculosis; Deaths; Risk Factors; Retrospective Cohort Study

Study contributions

Main results Risk of death was higher in the elderly, males, people with low education levels, homeless people, alcohol and tobacco users. Laboratory confirmation was a protective factor.

Implications for services Raising awareness of health professionals regarding risk factors, especially regarding risk behaviors and laboratory confirmation of tuberculosis, to which efforts should be targeted.

Perspectives It would be strategic to study survival in order to assimilate the effect of time and to study people with drug-resistant tuberculosis in order to update treatment recommendations. Health service managers need to define public policies aimed at the determinants found.

Demographic, socioeconomic and housing characteristics	Total n = 12.331		Tuberculosis cases
	Total n = 12.331		Non-deaths n = 11.806		Deaths n = 525		RR (95%CI)^a	p-value
	N	%	N	%	N	%	RR (95%CI)^a	p-value
Sex^b
Female	3.895	31,6	3.773	32,0	122	23,2	1,00	< 0,001
Male	8.436	68,4	8.033	68,0	403	76,8	1,52 (1,26;1,91)	< 0,001
Age distribution (years)^b
10-17	450	3,7	444	3,8	6	1,2	1,00	< 0,001
18-39	5.389	44,2	5.281	45,2	108	20,8	1,51 (0,66;3,46)	0,327
40-59	4.081	33,5	3.893	33,4	188	36,2	3,57 (1,58;8,10)	0,002
60+	2.271	18,6	2.053	17,6	218	41,9	7,86 (3,47;17,80)	< 0,001
Race/skin color^b
White	2.553	21,2	2.442	21,1	111	21,9	1,00	< 0,001
Non-white	9.508	78,8	9.111	78,9	397	78,1	0,96 (0,77;1,19)	< 0,001
Schooling^b
Complete or incomplete higher education	788	7,9	778	8,1	10	2,7	1,00	0,134
Complete elementary education and complete high school education	3.539	35,4	3.465	36,0	74	19,9	1,66 (0,86;3,23)	< 0,001
Incomplete elementary education and incomplete high school education	4.856	48,6	4.636	48,2	220	59,1	3,69 (1,95;6,99)	< 0,001
Illiterate	808	8,1	740	7,7	68	18,3	7,15 (3,65;13,99)	< 0,001
Street dweller^b
No	6.392	97,1	6.129	97,3	263	93,6	1,00	< 0,001
Yes	189	2,9	171	2,7	18	6,4	2,45 (1,49;4,49)	< 0,001
Health professionals^b
No	6.467	98,1	6.185	98,1	282	99,6	1,00	< 0,001
Yes	124	1,9	123	1,9	1	0,4	0,18 (0,03;1,28)	< 0,001
Immigrants^b
No	6.527	99,2	6.247	99,2	280	99,3	1,00	< 0,001
Yes	50	0,8	48	0,8	2	0,7	0,93 (0,23;3,84)	< 0,001
Deprived of liberty^b
No	9.519	85,9	9.086	85,4	433	96,9	1,00	< 0,001
Yes	1.567	14,1	1.553	14,6	14	3,1	0,19 (0,11;0,323)	< 0,001

Clinical and behavioral characteristics	Total n = 12.331		Tuberculosis cases
	Total n = 12.331		Non-deaths n = 11.806		Deaths n = 525		RR (95%CI)^a	p-value
	N	%	N	%	N	%	RR (95%CI)^a	p-value
Treatment^b
Caso novo	10.725	88,4	10.289	88,5	436	85,2	1,00	< 0,001
Retratamento	1.413	11,6	1.337	11,5	76	14,8	1,34 (1,04;1,72)	< 0,001
Observed treatment^b
Not observed	1.075	22,0	1.037	22,0	38	21,3	1,00	< 0,001
Observed	3.819	78,0	3.679	78,0	140	78,7	1,04 (0,72;1,50)	< 0,001
Alcohol use^b
No	9.377	84,5	9.035	84,8	342	76,3	1,00	< 0,001
Yes	1.722	15,5	1.616	15,2	106	23,7	1,73 (1,39;2,17)	< 0,001
Drug use^b
No	6.106	89,5	5.855	89,5	251	88,7	1,00	< 0,001
Yes	719	10,5	687	10,5	32	11,3	1,09 (0,75;1,58)	< 0,001
Tobacco use^b
No	5.391	78,3	5.195	78,7	196	70,5	1,00	< 0,001
Yes	1.491	21,7	1.409	21,3	82	29,5	1,54 (1,18;2,01)	< 0,001
Diabetes^b
No	10.153	92,6	9.755	92,8	398	89,0	1,00	0,003
Yes	807	7,4	758	7,2	49	11,0	1,58 (1,17;2,15)	0,003
HIV^b
No	6.701	87,6	6.442	87,8	259	84,1	1,00	0,056
Yes	948	12,4	899	12,2	49	15,9	1,36 (0,99;1,85)	0,056
Laboratory confirmation^b
No	5.807	47,1	5.494	46,5	313	59,6	1,00	< 0,001
Yes	6.524	52,9	6.312	53,5	212	40,4	0,59 (0,49;0,70)	< 0,001

	Total n = 12.331		Non-deaths n = 11.806		Deaths n = 525		Crude RR (95%CI)^a	Adjusted RR (95%CI)^a	p-value
	N	%	N	%	N	%	Crude RR (95%CI)^a	Adjusted RR (95%CI)^a	p-value
Age group^b
10-17	450	3,7	444	3,8	6	1,2	1,00	1,00
18-39	5.389	44,2	5.281	45,2	108	20,8	1,51 (0,66;3,46)	1,43 (0,35;5,87)	0,624
40-59	4.081	33,5	3.893	33,4	188	36,2	3,57 (1,58;8,10)	2,84 (0,70;11,54)	0,145
60+	2.271	18,6	2.053	17,6	218	41,9	7,86 (3,47;17,80)	7,70 (1,91;31,04)	0,004
Schooling^b
Higher education (complete or incomplete)	788	7,9	778	8,1	10	2,7	1,00	1,00
Complete elementary education and complete high school education	3.539	35,4	3.465	36,0	74	19,9	1,66 (0,86;3,23)	2,72 (0,98;7,56)	0,054
Incomplete elementary education and incomplete high school education	4.856	48,6	4.636	48,2	220	59,1	3,69 (1,95;6,99)	3,66 (1,34;9,96)	0,011
Illiterate	808	8,1	740	7,7	68	18,3	7,15 (3,65;13,99)	4,50 (1,60;12,66)	0,054
Street dweller^b
No	6.392	97,1	6.129	97,3	263	93,6	1,00	1,00	0,003
Yes	189	2,9	171	2,7	18	6,4	2,45 (1,49;4,049)	2,41 (1,34;4,35)	0,003
Alcohol use^b
No	9.377	84,5	9.035	84,8	342	76,3	1,00	1,00	0,027
Yes	1.722	15,5	1.616	15,2	106	23,7	1,73 (1,39;2,17)	1,45 (1,04;2,02)	0,027
Laboratory confirmation^b
No	5.807	47,1	5.494	46,5	313	59,6	1,00	1,00	0,014
Yes	6.524	52,9	6.312	53,5	212	40,4	0,59 (0,49;0,70)	0,68 (0,52;0,93)	0,014
Sex^b
Female	3.895	31,6	3.773	32,0	122	23,2	1,00	1,00	0,027
Male	8.436	68,4	8.033	68,0	403	76,8	1,52 (1,26;1,91)	1,48 (1,04;2,09)	0,027
Tobacco use^b
No	5.391	78,3	5.195	78,7	196	70,5	1,00	1,00	0,259
Yes	1.491	21,7	1.409	21,3	82	29,5	1,54 (1,18;2,01)	1,32 (0,98;1,77)	0,259

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Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 (61) 3315-3464 - Brasília - DF - Brazil
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[TFN1] a) RR: Relative Risk; 95%CI: 95% confidence interval; b) The difference in relation to the total number of cases (100%) corresponds to the number of cases that were unknown, left blank or filled in with data not corresponding to the tuberculosis Dictionary.