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Factors associated with death in patients with tuberculosis in Brazil: survival analysis with competitive risks

Abstract

Background: This study aimed to analyze the factors associated with deaths caused by TB, TB-related causes and deaths from other causes. Methods: A retrospective, population-based cohort study of the causes of death, using a survival regression model in the presence of competitive risk in a cohort of patients in treatment for TB was performed using records of patients that started TB treatment in Brazil and death certificates from 2008 to 2013. Results: In this cohort, 39,997 individuals (14.1%) died, out of a total of 283,508 individuals. Of these, 8,936 deaths due to TB (22.4%), 3,365 deaths to associated TB (8.4%), revealing a high rate of lethality. 27,696 deaths (69.2%) were from other causes. From our analysis, factors strongly associated with death from TB were male gender (sHR = 1.33, 95% CI: 1.26-1.40), older than 60 years (sHR = 9.29, 95% CI: 8.15-10.60), illiterate schooling (sHR = 2.33, 95% CI: 2.09-2.59), black (sHR = 1.33, 95% CI: 1.26-1.40) and brown color/race (sHR = 13, 95% CI: 1.07-1.19), from the southern region (sHR = 1.19, 95% CI: 1.10-1.28), mixed forms (sHR = 1.91, 95% CI: 1.73 -2.11) and alcoholism (sHR = 1.90, 95% CI: 1.81-2.00). Also, HIV positive serology was strongly associated with death due to TB (sHR = 62.78; 95% CI: 55.01 - 71.63). Conclusions: We believe that specific active surveillance strategies and early case finding could reduce mortality among tuberculosis patients, leading to a more timely detection and treatment.

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