Abstract
ObjectivesEstimate TB mortality rates, catalogue multiple causes on death certificates in which TB was reported and identify predictors of TB from reporting on death certificates in the State of Amazonas, Brazil, based on a multiple cause of death approach.MethodsThe death records of residents in the Amazonas state between 2006–2014 were analyzed and separated into three categories: TB not reported on the death certificate (TBNoR), TB reported as the underlying cause of death (TBUC) and TB reported as an associated cause of death (TBAC). Age standardized annual mortality rates for TBUC, TBAC and with TB reported (TBUC plus TBAC) were estimated for the State of Amazonas using the direct standardization method and World Health Organization 2000–2025 standard population. Mortality odds ratios (OR) for reporting of TBUC and TBAC were estimated using multinomial logistic regression.ResultsAge standardized annual TBUC and TBAC mortality rates ranged between 5.9–7.8/105 and 2.7–4.0/105, respectively. TBUC was associated with being a resident in the State capital (OR = 0.66), of female gender (OR = 0.87), having an education level of 8 to 11, or 12 or more school years (OR = 0.67 and 0.50 respectively), non-white race/skin color (OR = 1.38) and place of death reported as in the State capital (OR = 1.69). TBAC was related to the triennium in which death occurred (OR = 1.21 and 1.22 for the years 2009–2011 and 2012–2014 respectively), age (OR = 36.1 and 16.5 for ages 15–39 and 40–64 years respectively) and when death occurred in the State capital (OR = 5.8).ConclusionsTBUC was predominantly associated with predictors of unfavorable socioeconomic conditions and health care access constraints, whereas TBAC was mainly related to ages which were typical of high HIV disease incidence.
Highlights
Tuberculosis ranks as the ninth leading cause of death and the leading cause of death by a single infectious agent [1]
TBUC was associated with being a resident in the State capital (OR = 0.66), of female gender (OR = 0.87), having an education level of 8 to 11, or 12 or more school years (OR = 0.67 and 0.50 respectively), non-white race/skin color (OR = 1.38) and place of death reported as in the State capital (OR = 1.69)
TBUC was predominantly associated with predictors of unfavorable socioeconomic conditions and health care access constraints, whereas TBAC was mainly related to ages which were typical of high HIV disease incidence
Summary
Tuberculosis ranks as the ninth leading cause of death and the leading cause of death by a single infectious agent [1]. In Brazil, one of the countries considered to have a high tuberculosis burden according to the World Health Organization (WHO), 72,788 new TB cases were recorded in 2018, and in 2017 there were 4,534 deaths from the disease. Tuberculosis remains a public health threat on a nationwide level with markedly heterogeneous patterns of morbidity and mortality [2]. The State of Amazonas has historically been among the highest in the ranking levels for tuberculosis incidence and mortality in Brazil. For all forms of tuberculosis, the state’s incidence rate (72.9/100,000) ranked first in 2018 and, in 2017, its mortality rate (3.9/100,000) was third among Brazilian States, exceeding the corresponding national incidence (34.8/1000,000) and mortality (2.2/100,000) estimates by 2.1 and 1.8 times [2]
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