Risk factors to unfavorable outcomes of tuberculosis in pandemic and post-pandemic period in Brazil

Background

Tuberculosis has once again become the leading cause of death from infectious disease worldwide and vulnerable populations are the most affected.

Aim

To identify the risk factors associated with unfavorable outcomes in people with tuberculosis during the Covid-19 pandemic, compared to the post-pandemic period in Brazil.

Methods

The study analyzed cases of pulmonary tuberculosis diagnosis, between 2020 and 2024 in individuals over 18 years of age in the state of São Paulo. Variables: dependent (unfavorable outcome – loss of follow-up, failure, death, drug resistance), independent (sex, age, ethnicity, education, diabetes, alcoholism, illicit drug use, smoking, HIV, incarcerated population, homeless). Multiple Logistic Regression models were developed disaggregated by pandemic period (2020-2022), post pandemic period (2023–2024).

Results

During the pandemic, 37,877 tuberculosis cases were diagnosed, of which 24.3% had an unfavorable outcome for treatment; in the post-pandemic period, there were 28,996 cases and 27.6% had an unfavorable outcome. The risk factors were consecutively between the periods 2020–2022 / 2023–2024 (both, age-adjusted): being male (OR 1.40, CI 1.32–1.49 / OR 1.31, CI 1.23–1.39); being of ethinicy: Pardo (mixed ethnicity) (OR 1.08, CI 1.02–1.14 / OR 1.16, CI 1.09–1.23) or black (OR 1.16, CI 1.07–1.26 / OR 1.19, CI 1.09–1.30, Ref.: White); being homeless (OR 2.49, CI 2.24–2.77 / OR 2.82, CI 2.51–3.15); being HIV positive (OR 2.24, CI 2.04–2.45 / OR 1.63, CI 1.48 – 1.79); alcohol user (OR 1.42, CI 1.33 – 1.52 / OR 1.31, CI 1.22 – 1.41); smoker (OR 1.14, CI 1.08 – 1.21 / OR 1.17, CI 1.10 – 1.25) and illicit drug use (OR 1.76, CI 1.65 – 1.88 / OR 1.90, CI 1.77 – 2.04).

Conclusions

Both models present the same risk factors for the unfavorable outcome. The risk factor that differed between the periods of the analyzed models was being HIV positive, which decreased the risk of the unfavorable outcome in the post-pandemic period.

Key messages

• Negative outcomes increased after the pandemic. Vulnerable groups (men, black/pardo people, homeless people, and drug users) presented higher risk of unfavorable outcomes in both periods.

• People living with HIV were at higher risk for adverse outcomes during the pandemic period. The integration of health policies is necessary.