Risk of Death From Pulmonary Tuberculosis Attributable to Diabetes Mellitus in Brazil: A Retrospective Cohort Study of Health Surveillance Data

TL;DR

This study finds that diabetes significantly increases the risk of death from tuberculosis in Brazil, especially in certain subgroups.

Contribution

The study quantifies the increased mortality risk from tuberculosis in diabetic patients in Brazil and identifies high-risk subgroups.

Findings

Diabetes mellitus increases pulmonary tuberculosis fatality rates by 34.6% in Brazil.

Subgroups with the highest attributable risk include younger patients, peri-urban residents, and BCTP recipients.

Diabetic patients had higher mortality but lower treatment discontinuation rates compared to non-diabetic patients.

Abstract

Background: Diabetes mellitus (DM) is associated with increased susceptibility to tuberculosis (TB) and unfavorable treatment outcomes.

Objective: To evaluate the risk of pulmonary tuberculosis (PT)-related mortality attributable to DM in Brazil and to identify subgroups that may require differentiated clinical management.

Methods: Descriptive and retrospective cohort study using data from Brazil’s national health surveillance system. Data on new PT cases in individuals aged ≥18 years, diagnosed between 2012 and 2017, were analyzed. Fatality rates were compared between patients with and without self-reported DM, stratified by relevant covariates, to estimate the attributable risk due to DM (ARDM%).

Results: A total of 355,659 patients with PT were included in the analysis of this study, of whom 29,579 (8.3%) had PT-DM, and 326,080 (91.7%) had PT alone, without DM. Patients with PT-DM exhibited higher PT fatality rates (1,691, 5.7%) and lower treatment discontinuation rates (2,425, 8.2%) than those without DM (12,203, 3.7%) or who completed the full course of treatment (50,216, 15.4%). Overall, DM accounted for a 34.6% increase in PT fatality (ARDM%). The highest ARDM% (>50%) was observed among patients with higher education levels, those aged 18-39 years, residents of peri-urban areas, recipients of the Brazilian Cash Transfer Program (BCTP), and incarcerated individuals.

Conclusions: DM substantially increases the fatality rate among patients with PT in Brazil, particularly in specific subgroups that may benefit from targeted clinical and public health interventions.

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