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

Abstract

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.

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Cite

BibTeX RIS

BibTeX

@article{lima2026risk,
  title = {{Risk factors to unfavorable outcomes of tuberculosis in pandemic and post-pandemic period in Brazil}},
  author = {MCRAA Lima and MPG Serrano and JWP Borges and DHM Silva and RLP Andrade-Gonçalves and CBA Ferreira and JGA Ballestero and A P Monroe and P F Palha},
  journal = {The European Journal of Public Health},
  year = {2026},
  month = oct,
  doi = {10.1093/eurpub/ckag169.1638},
  url = {https://doi.org/10.1093/eurpub/ckag169.1638},
  note = {CC BY-NC 4.0},
}

RIS

TY  - JOUR
TI  - Risk factors to unfavorable outcomes of tuberculosis in pandemic and post-pandemic period in Brazil
AU  - MCRAA Lima
AU  - MPG Serrano
AU  - JWP Borges
AU  - DHM Silva
AU  - RLP Andrade-Gonçalves
AU  - CBA Ferreira
AU  - JGA Ballestero
AU  - A P Monroe
AU  - P F Palha
PY  - 2026
DA  - 2026/10/01
JO  - The European Journal of Public Health
DO  - 10.1093/eurpub/ckag169.1638
UR  - https://doi.org/10.1093/eurpub/ckag169.1638
AB  - 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.
SN  - 1101-1262
SN  - 1464-360X
ER  -

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