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

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 Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES) (Finance code: 001). MBA received a fellowship from the Fundacao de Amparo a 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.