Time until tuberculosis recurrence and associated factors in Brazil: a populationbased retrospective cohort study...

Area of Science:

• Epidemiology and Public Health
• Infectious Diseases
• Social Medicine

Background:

• Tuberculosis (TB) remains a significant global health challenge, with recurrence posing a threat to disease control efforts.
• Understanding recurrence patterns is crucial for developing effective strategies to combat TB transmission and reduce disease burden.

Purpose of the Study:

• To determine the incidence rate of TB recurrence in Brazil.
• To estimate the median time to TB recurrence.
• To identify demographic, clinical, and social factors associated with TB recurrence in the Brazilian population.

Main Methods:

• A retrospective cohort study utilizing linked data from the Notifiable Diseases Information System (SINAN).
• Inclusion criteria: individuals diagnosed with TB in 2015, with analysis focused on first recurrence within a 6.5-year follow-up period.
• Statistical analysis included relative risk (RR) and population attributable fraction (PAF)/population preventable fraction (PPF) calculations.

Main Results:

• A total of 3,253 individuals (6.5%) experienced TB recurrence within 6.5 years, with a median time of 2.2 years.
• Factors positively associated with recurrence: male sex, age 30-59, black and mixed race, incarceration, pulmonary/mixed TB forms, HIV diagnosis, and alcohol use.
• Factors negatively associated with recurrence: higher education (≥12 years) and supervised treatment.

Conclusions:

• Brazil faces a substantial burden of TB recurrence, influenced by a complex interplay of sociodemographic, clinical, and social factors.
• Identifying individuals at higher risk due to factors like male sex, specific age groups, race, social deprivation, and comorbidities is essential.
• Interventions targeting these risk factors, alongside promoting supervised treatment and education, are critical for reducing TB recurrence rates.