Social, demographic, health care and co-morbidity predictors of tuberculosis mortality in Amazonas, Brazil: a multiple cause of death approach

OBJECTIVESTo estimate TB mortality rates, describe multiple causes in death certificates in which TB was reported and identify predictors of TB reporting in death certificates in the State of Amazonas, Brazil, based on a multiple cause of death approach.METHODSDeath records of residents in AM within 2006-2014 were classified based on tuberculosis reporting in the death certificate as tuberculosis not reported (TBNoR), reported as the underlying cause of death (TBUC) and as an associate cause of death (TBAC). Age standardized annual mortality rates for TBUC, TBAC and with TB reported (TBUC plus TBAC) were estimated for the State of Amazonas, using the direct standardization method and WHO 2000-2025 standard population. Mortality odds ratios (OR) of reporting TBUC and TBAC were estimated using multinomial logistic regression.RESULTSAge standardized annual TBUC and TBAC mortality rates ranged, between 5.9-7.8/105 and 2.7-4.0/105, respectively. TBUC was associated with residence in the State capital (OR=0.66), female sex (OR=0.87), education level (OR=0.67 and 0.50 for 8 to 11 and 12 or more school years), non-white race/skin colour (OR=1.38) and occurrence of death in the State capital (OR=1.69). TBAC was related to time (OR=1.21 and 1.22 for years 2009-11 and 2012-14), age (OR=36.1 and 16.5 for ages 15-39 and 40-64 years) and when death occurred in the State capital (OR=5.8).CONCLUSIONTBUC was predominantly associated with indicators of unfavorable socioeconomic conditions and health care access constraints, whereas TBAC was mainly related to ages typical of high HIV disease incidence.Conflicts of interestNone.FundingFundação de Amparo à Pesquisa do Estado do Amazonas - FAPEAM