Tuberculosis Burden and Determinants of Treatment Outcomes According to Age in Brazil: A Nationwide Study of 896,314 Cases Reported Between 2010 and 2019

Abstract

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 public health policy implementation and clinical management to improve outcomes. We obtained data from the national tuberculosis case registry; data were reported to the Brazilian National Program (SINAN) between 2010 and 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. There were 896,314 tuberculosis cases reported during the period. Tuberculosis incidence was highest among adult males, but the young males presented the highest growth rate during 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. 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 age and sex identified adults and young males as the groups that need prevention efforts. This supports implementation of DOT in all populations to improve tuberculosis outcomes.

Factors Associated with the Abandonment of Tuberculosis Treatment in Brazil: A Systematic Review

“…Thus, corroborated by the findings of other studies, our research also concludes that DOT is crucial for linking individuals to service and care 21 , 29 , 37 , 38 . During DOT, it is possible to diagnose the potential difficulties faced by patients, allowing for intervention when necessary 21 , thereby avoiding treatment dropout.…”

“…The Ministry of Health considers DOT to be a minimum of three weekly observations by a healthcare professional on the patient’s medication intake during the whole treatment, totaling at least 24 doses in the intensive phase and 28 doses in the maintenance phase (under a standardized six-month treatment) 21 , 38 .…”

“…During DOT, it is possible to diagnose the potential difficulties faced by patients, allowing for intervention when necessary 21 , thereby avoiding treatment dropout. DOT is also associated with an increase in favorable outcomes 38 .…”

Real-world association of adherence with outcomes and economic burden in patients with tuberculosis from South Korea claims data

“…Adherence and comorbidity were not related; however, many factors have been shown to be associated with adherence to TB treatment, including patient characteristics, treatment regimens, and healthcare settings ( WHO, 2003 ). Previous systematic reviews and studies showed that diabetes and chronic renal failure lead to an increase in poor outcomes, particularly death, in patients with TB ( Baker et al, 2011 ; Baghaei et al, 2014 ; Barreto-Duarte et al, 2021 ). Interestingly, interstitial pulmonary disease is associated with adherence and costs.…”

Marcadores farmacogenéticos baseados em dados genômicos de uma coorte de idosos da cidade de São Paulo e o panorama da farmacogenômica no Brasil

“…Tuberculosis remains an important public health problem throughout the world and Brazil is one of the 22 countries with high tuberculosis burdens identified by WHO (Barreto-Duarte et al, 2021). Nine studies analysed antiinfectives used for tuberculosis treatment, analysing predominantly pharmacogenes coding for drug metabolism enzymes (NAT2, CYP2E1, GSTT1) and outcomes of adverse events (Costa et al, 2012;Forestiero et al, 2013;Heinrich et al, 2016;Monteiro et al, 2012;Possuelo et al, 2008;Santos et al, 2013;Teixeira et al, 2011;Zaverucha-do-Valle et al, 2014), and drug effect of ABCB1 transporter (Pontual et al, 2017).…”