Profile of tuberculosis patients progressing to death, city of São Paulo, Brazil, 2002.
OBJECTIVE
To profile adult patients dying of tuberculosis in the city of São Paulo with respect to biological, environmental and institutional factors.


METHODS
Descriptive study covering all tuberculosis deaths (N=416) among individuals aged over 15 years in 2002. Data were obtained from hospital records, the local Mortality Information System, Coroner's Service, and tuberculosis Surveillance System. The estimates of relative risk and 95% confidence intervals (95% CI) were based on the reference group, i.e., females aged 15 to 29 years, originally from the State of São Paulo (Brazil). A comparative analysis was conducted using Pearson's chi-square test and Fisher's exact test for categorical variables and Kruskal-Wallis test for continuous variables.


RESULTS
Of all tuberculosis deaths identified, 78% had pulmonary form. Tuberculosis diagnosis was made after death in 30% and in primary health care units in 14%. Of them, 44% had not started treatment; 49% were not notified; and 76% were men. The median age was 51 years; 52% had up to four years of schooling; 4% were probably living in the streets. Mortality rate increased with age; it was 5.0/100,000 for the entire city, ranging between zero to 35 according to the district. Previous treatment was reported for 82 out of 232 patients, and of them, 41 defaulted treatment. Diabetes (16%), chronic obstructive pulmonary disease (19%), HIV infection (11%), smoking (71%), and alcohol abuse (64%) were also reported.


CONCLUSIONS
Adult males over 50, migrants and living in lower Human Development Index districts were more likely to die of tuberculosis. Low schooling and comorbidities are relevant characteristics. Low involvement of primary care units in tuberculosis diagnosis and high underreporting of cases were also seen.
Lindoso
Ana Angélica Bulcão Portela
AA
Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Waldman
Eliseu Alves
EA
Komatsu
Naomi Kawaoka
NK
Figueiredo
Sumie Matai de
SM
Taniguchi
Mauro
M
Rodrigues
Laura C
LC
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002423:Cause of Death; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects; D013223:Statistics as Topic; D015996:Survival Rate; D014376:Tuberculosis / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D055815:Young Adult