A tuberculose e os fatores associados ao óbito e ao abandono do tratamento

Abstract

Introduction: Tuberculosis prevails as one of the most challenging public health problems in the world, and the political and social effort for its control is important. Epidemiological indicators of death and treatment abandonment are important mechanisms for assessing the epidemiological situation of the disease, and knowledge of the aspects that directly interfere with these indicators is essential. Objective: To investigate factors associated with death and abandonment of tuberculosis treatment. Methodology: This is an observational and analytical study with a quantitative approach, carried out with all cases of sensitive tuberculosis and resistant drug reported in the period from 2010 to 2019 in the Diseases Information System and in the Special Treatment Information System of the Tuberculosis. Descriptive statistical analysis was carried out, aiming to characterize the sample. Then, Pearson's chi-square test was used to determine the association between the occurrence of “abandonment” or “death” and the independent variables. The level of significance was set at p <0.05. Subsequently, Poisson regression analysis was performed to determine the magnitude of the associations. Relative risk measures (RR) were calculated with their respective 95% confidence intervals. In order to ensure greater adjustment in the final adjusted model, variables with a percentage of lost data greater than 10% were not included. Results: In the unadjusted analysis, it was identified that factors associated with the occurrence of abandonment were: young age group, ≤ 29 years (RR = 2.220; 95% CI = 1.959-2.517), male gender (RR = 1.506; 95% CI = 1.358-1.670), education less than 8 years of study (RR = 1.511; 95% CI = 1.347-1.695), new cases (RR = 1.175; 95% CI = 1.027-1.344) and pulmonary-type clinical form (RR = 1.638; 95% CI = 1.414-1.897). In addition, they also demonstrated an association with the occurrence of abandonment: patients with AIDS (RR = 1.837; 95% CI = 1.620-2.083), alcoholics (RR = 1.837; 95% CI = 1.620-2.083), non-diabetics (RR = 1.587; 95% CI = 1,313-1,920), people living with HIV (RR = 2,131; 95% CI = 1,843-2,463), users of illicit drugs (RR = 2,268; 95% CI = 1,945-2,644), smokers (RR = 1,782 ; 95% CI = 1.555-2.043), not submitted to DOT (RR = 1.492; 95% CI = 1.341-1.659) and tuberculosis resistant drug patients (RR = 1.846; 95% CI = 1.401-2.431). In the adjusted analysis, the associations continued to be statistically significant between occurrence of dropout: young age group, ≤ 29 years (RR = 1,873; 95% CI = 1,638-2,141), male (RR = 1,469; 95% CI = 1,323-1,630) , people living with HIV (RR = 1,836; 95% CI = 1,584-2,127) and tuberculosis resistant drug patients (RR = 1,594; 95% CI = 1,199-2,120). In relation to death, in the unadjusted analysis, it was identified that factors associated with the occurrence of death were: older age, ≥ 50 years (RR = 4.339; 95% CI = 3.384-5.564), male (RR = 1.233; 95% CI = 1.013-1.478), individuals with less than 8 years of schooling (RR = 1.654; 95% CI = 1.312-2.084), alcoholics (RR = 1.548; 95% CI = 1.289-1.858), diabetics ( RR = 1.525; 95% CI = 1.179-1.972), patients not submitted to ODD (RR = 1.369; 95% CI = 1.092-1.716) and TB drug resistant patients (RR = 3.920; 95% CI = 2.778-5.530) . In the adjusted analysis, the associations were statistically significant between the occurrence of death, age group> 50 years (RR = 4,243; 95% CI = 3,294-5,466), male gender (RR = 1,271; 95% CI = 1,055-1,531) and patients drug resistant tuberculosis (RR = 3.959; 95% CI = 2.675-5.860). Final considerations: The findings are of great relevance to support tuberculosis control actions, which should intervene in factors that hinder treatment adherence, improving epidemiological indicators of abandonment and death.