Sobrevida dos indivíduos com tuberculose residentes em Recife, PE, 1996-2001

Abstract

Declared in 1993 by the WHO as a global emergency as a result of the serious epidemic, tuberculosis continues to be one of the most serious public health issues of the world, mainly in the developing countries where 95% of the cases have occurred and 99% of the deaths. Eighty percent of the registered cases are concentrated in 22 countries and more than 50% of the cases occur in countries with failures in control, which include Brazil. Recife, capital of the State of Pernambuco has one of the highest incidences and mortality of tuberculosis in Brazil. This non-concurrent prospective study was aimed at assessing the survival of individuals with tuberculosis living in Recife, PE, notified to the Notification Information System from January 1996 to June 2001. Information on deaths as a result of tuberculosis and association with AIDS have been verified and checked on the SIM data base and SINAN_AIDS database. The analysis included Kaplan-Méier methodology and Cox proportional risks models with Uni and multi varied instantaneous risk (RI) measures. The coefficient of incidence of notified cases of tuberculosis was of 97,3 and mortality reached 12,9 for 100.000 inhab in Recife in the period. For the survival study, the historical cohort was of 5215 individuals out of which 439 (8,4%) have died as a consequence of tuberculosis. Different survival measures have been found in the individuals subgroups. The average was 49 months for the surveyed group, however dramatically reduced for the associated pulmonary and extra pulmonary modes (22.2 months); for association TB/AIDS (10.3 months) and for groups of individuals whose reentry into the system was caused by abandonment (38.3 months). The risk to die as a result of tuberculosis, after adjusted for possible variations of confusion was independently significant for those over 50 years old (RR: 6,0 IC 95% 3.3 - 10.9) as compared to those under 20 years old; for those with both pulmonary and extra pulmonary tuberculosis at once (RR: 2.5 IC 95% 1,8 - 3.6) as compared to the pulmonary tuberculosis only; for those who joined the system with diagnosis of abandonment (RR: 1.8 IC 95% 1.3 - 2.4) as compared to new cases and for association with AIDS (RR: 8.4 IC 95% 6.6 - 10.7) as compared to the absence of association. Stratifying by the presence of AIDS, all the estimators continued independently significant in the multi varied models of the section without AIDS. In this section, the risk to die for those with return after abandonment went up to 2.3 (IC 95% 1.5 - 3.2) as compared to new cases. In the section with AIDS, all variables have lost statistical significance in the multivaried model. Tuberculosis continues to be a serious public health problem in Recife and an important cause of morbi-mortality with high coefficients of incidence and mortality. HIV/AIDS has represented an important determinant factor of mortality in patients, however, among those without HIV/AIDS the prognostic factors independently associated have been: those over 50 years old; extrapulmonary tuberculosis associated with pulmonary tuberculosis and those returning after abandoning the treatment. Public health actions shall be organised in order to minimize damages of a treatable illness for: certain ages, various cases and patients who abandon the treatment. Further researches on abandonment are recommended.