A study examined excess mortality among people diagnosed with tuberculosis (TB) in Brazil and assessed how mortality during the TB episode and the post-TB period contributed to long-term mortality. Using a retrospective population-based cohort design, investigators linked TB notifications from Brazil’s National Notifiable Disease Information System (SINAN) with mortality records from the Mortality Information System (SIM) for 2007–2016. The objective was to compare mortality among individuals with TB against the general population and evaluate how causes of death evolved over time after TB diagnosis.
The analysis included 834,594 individuals with TB after excluding records with postmortem diagnoses, revised non-TB diagnoses, missing demographic information, and individuals aged 90 years or older. Participants contributed 4,089,883 person-years of follow-up, with a mean follow-up of 4.9 years. Deaths were identified through linked mortality records and categorized into 11 cause-of-death groups based on ICD-10 codes. The primary outcome was mortality rate ratios (MRRs) comparing the TB cohort with the general population by year since diagnosis. The TB episode was defined as the first 12 months after diagnosis, while follow-up beyond 12 months was considered the post-TB period. Analyses were stratified by age, sex, and region, and adjusted MRRs (aMRRs) were estimated for risk factors associated with mortality.
Among 834,594 individuals, 120,330 deaths occurred during follow-up (14.4%). Mortality was markedly elevated during the first year after TB diagnosis (MRR 11.28, 95% CI 11.18–11.37) and declined over time but remained above that of the general population even 10 years later (MRR 1.46, 95% CI 1.34–1.59). During the TB episode, mortality was highest among individuals aged 30–44 years (MRR 24.97, 95% CI 24.59–25.33) and lowest among those aged 75–89 years (MRR 4.04, 95% CI 3.94–4.15). HIV infection was the strongest predictor of mortality during the TB episode (aMRR 5.16, 95% CI 5.05–5.27). Other factors associated with higher mortality included female sex (aMRR 1.67, 95% CI 1.64–1.70), combined pulmonary and extrapulmonary TB (aMRR 1.57, 95% CI 1.52–1.62), and abnormal chest X-ray findings (aMRR 1.77, 95% CI 1.65–1.89). During the post-TB period, elevated mortality remained associated with HIV infection (aMRR 2.80, 95% CI 2.73–2.87), treatment reinitiation after abandonment (aMRR 1.78, 95% CI 1.74–1.84), alcohol use disorder (aMRR 1.52, 95% CI 1.49–1.55), female sex (aMRR 1.41, 95% CI 1.38–1.43), treatment loss to follow-up, and drug-resistant TB requiring regimen changes (aMRR 1.65, 95% CI 1.53–1.77). Excess mortality accumulated substantially over time. At 1 year, cumulative mortality was 6.82% in the TB cohort versus 0.70% in the general population, yielding 6.12% excess mortality. By year 10, cumulative mortality reached 17.88% versus 7.97%, corresponding to 9.90% excess mortality, of which 5.22% occurred during the post-TB period. Causes of death shifted over time. In the first year, TB (31.3%) and HIV (23.9%) were the leading causes of death. By year 10, respiratory disease (16.3%), cardiovascular disease (16.1%), and cancer (13.3%) became the predominant causes.
The findings indicate that TB is associated with substantial excess mortality that persists for at least a decade after diagnosis, with more than half of total excess mortality occurring after completion of the initial TB episode. This large national cohort provides strong observational evidence, although causal inference is limited by its retrospective design and reliance on routinely collected administrative data. The results suggest that long-term follow-up and management of chronic comorbidities may be important components of care for TB survivors.
Source: Kim S, Pelissari DM, Harada LO, Sanchez M, Oliveira PB, Johansen FD, Maciel EL, Cohen T, Castro MC, Menzies NA. Long-term mortality trends among individuals with tuberculosis: a retrospective cohort study of individuals diagnosed with tuberculosis in Brazil. Clinical Infectious Diseases. 2026 Jan 15;82(1):e1-8.
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