Multiple-causes-of-death related to tuberculosis in the state of Sao Paulo, Brazil, 1998

Objectives The goal of this paper is to investigate mortality related to tuberculosis in the state Of Sao Paulo, southeastern Brazil, according to multiple causes of death and their interrelation with other underlying causes. Methods The study investigated deaths related to tuberculosis that occurred in the state of sao Paulo in 1998. Data were obtained from the Fundaco Sistema Estadual de Analise de Dados (State System for Data Analysis Foundation - SEADE) database. Causes of death by clinical forms of TB were coded in block A15-A19, and by its sequelae in category B90, according to the guidelines proposed by the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems. Tabulador de Causas Multiplas (Multiple Cause Tabulator - TCM) software was used for processing associated causes of death. Statistical analysis included analysis of variance, Student t-distribution, and chi-squared tests. Results TB was the underlying cause of 1,644 deaths, a 4.61100,000 population mortality rate. Main associated causes were respiratory failure (46,9%), pneumonias (16.5%), other specified symptoms and signs involving circulatory and respiratory systems (13.9%), cachexia (12.9%), diseases of the circulatory system (10.3%), conditions due to alcohol use (8.4%), septicemias (7.2%) and malnutrition (7.1%). Tuberculosis occurred as an associated cause in another 1, 388 deaths. The mortality rate including TB as a both underlying and associated cause was 8.91100,000 population, practically twice the classical rate. Deaths whose associated cause was reported as being TB had as underlying causes: AIDS (65.3%), diseases of the circulatory system (8.9%), neoplasms (7.5%), and diseases of the digestive system (4.8%). Clinical forms of nervous system and miliary TB were more frequent as a cause associated with AIDS than with other underlying causes (p < 0,001). Conclusions Total reports of TB-related death practically doubled its mortality rate as an underlying cause. The increase in TB mortality was demonstrated to be influenced by the AIDS epidemic.