Long-term risk of death after Tuberculosis diagnosis and treatment in Brazil: a nationwide longitudinal study using linked routine data between 2004 and 2018.

Tuberculosis (TB) remains a major societal burden, yet data on long-term mortality following diagnosis and treatment are limited. We conducted a nationwide Brazilian cohort study using linked data (2004-2018) to quantify long-term mortality (up to 14 years) following TB. We matched: (i)individuals diagnosed with TB or (ii)individuals who had completed TB treatment to TB-free individuals. We used competing risk methods to analyse natural causes (i.e., defined as deaths excluding TB, HIV, and external causes) and cause-specific mortality. In the diagnosed cohort (185,921 pairs), the risk of 14-year natural cause mortality was significantly higher (Risk Ratio [RR]=2.16, 95%CI=1.96-2.37); RRs were significantly elevated for deaths due to cancer, cardiovascular, endocrine, respiratory, and external causes. The treated cohort (111,871 pairs) showed elevated natural cause mortality risk (RR=1.77,1.55-2.03), with similarly increased RRs across specific causes. We showed that TB survivors, even after treatment, faced a significantly elevated, prolonged risk of death from various causes up to 14 years later. This emphasises the need for long-term monitoring to reduce the burden of TB.