Early death by tuberculosis as the underlying cause in a state of Southern Brazil: Profile, comorbidities and associated vulnerabilities

Abstract

To know the profile of adults who died by tuberculosis as the main cause, the time interval between the diagnosis and death, associated comorbidities and vulnerabilities. Method: Observational study of secondary data regarding deaths by tuberculosis that occurred in the State of Paraná, Brazil, from 2008 to 2015. A linkage between the databases of mortality and tuberculosis notification system was conducted for data enrichment. Frequency tables, Exact Fisher test and Z test have identified statistical associations. Results: Linkage points out 12.1% (115/944) of under-reporting in the 944 deaths identified. Early deaths accounted for 74.6% (705/944). The male sex (75.8%) was associated with the early death group. Almost half of the deaths reported in notification system (414/829) had one or more vulnerabilities. Early death were associated with respiratory system diseases and symptoms (p = 0.0001) and mental and behavioral disorders (p = 0.0001). Conclusion: High number of early deaths due TB indicate the need to seek out the respiratory symptomatic and use faster diagnostic methods. Strategies for treatment adherence, adequate monitoring of comorbidities and multisectorial support may prevent early and late death. The presence of vulnerabilities indicates that efforts beyond the health sector are needed in order to eliminate tuberculosis as public health problem.

Quality of tuberculosis information systems after record linkage

“…Concerning level of education, there was an increase in this study in cases with complete/incomplete higher education (4.34%). It is reinforced that patients with higher education may have more access to health services and diagnosis, even in the advanced stage of TB or at death, than those with fewer years studying and low social status, but who even at death may not be diagnosed with TB (8,10) .…”

“…However, underreporting of cases in SINAN is a reality and impairs real knowledge of the epidemiological situation of TB and the planning of actions aimed at its control (6)(7) . In this regard, probabilistic record linkage aims to improve the surveillance of a particular disease or disease to the extent that the combination of databases of qualitatively distinct information systems occurs, to promote case record improvement, excluding duplicates and including cases that would not have been identified if only one surveillance information system had been used (8)(9) . Analysis of SIM and SINAN databases through linkage allows identifying the epidemiological profile of TB cases, complementary analyses on surveillance, monitoring and care of cases (10) .…”

Screening People with Tuberculosis for High Risk of Severe Illness at Notification: Programmatic Experience from Karnataka, India

“…Most of the deaths in the high TB burden countries occur ‘early’, within two months of treatment initiation and are primarily due to severe illness and late presentation [ 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. These can be averted by detecting the missing 2.7 million people with TB (including drug-resistant forms and those with co-morbidities) as early as possible and treating them appropriately [ 11 ].…”

Os determinantes da mortalidade por Tuberculose e TB-HIV no Sul do Brasil: Da abordagem espacial à análise de sobrevida

“…Entre os determinantes correlacionados à mortalidade por TB, por meio dos estudos de abordagem individual e utilizando análises como regressão, foi observado que os principais fatores identificados foram: sexo masculino (OLIVEIRA et al, 2019;YEN et al, 2012), idade avançada (LEE et al, 2017;YEN et al, 2019;WU et al, 2015;YAMAMURA et al, 2015;WANG et al, 2013;YEN et al, 2012;GAIFER et al, 2016), presença de comorbidades como doenças do aparelho respiratório, derrame pleural (OLIVEIRA et al, 2019;WANG et al, 2013), doença renal (YEN et al, 2017;YEN et al, 2012).…”

“…Alguns estudos (OLIVEIRA et al, 2019;FERREIRA et al, 2018;LEE et al, 2017;PECEGO et al, 2016;BIGNA et al, 2015;FIELD et al, 2014) investigaram as mortes precoces por TB e fatores associados e, dentre aqueles identificados, encontraram a presença de comorbidades como HIV (CECCON et al, 2017;GESESEW et al, 2016;GAIFER et al, 2016;PECEGO et al, 2016;FIELD et al, 2014 ), doenças do aparelho respiratório, derrame pleural (OLIVEIRA et al, 2019;YEN et al, 2017)…”