Analysis of the tuberculosis trend in the S. Paulo state (SPS) 1998 to 2007

Introduction: Brazil is the 15th among the 22 TB highest burden countries of the world; one in five tuberculosis (TB) cases in the whole country occurs in  SPS. The greater São Paulo City, the largest South American Metropolitan Area contributes with a good number of cases. Keeping track of case distribution by disease form, age group, treatment story, HIV status, as well as trend analyzing is essential for establishing and evaluating Tuberculosis Control Programme performance.  

 Objective: To analyze the tuberculosis trend in the SPS during the 1998-2007 period.

 Methodology: Incidence rates (IR) and linear regression curves of tuberculosis cases notified in the tuberculosis data system of SPS (1998 a 2007) were analyzed. The linear regression was selected, since it provides best adjustment for morbidity indicators.

Results:  An yearly 2% linear decline trend of IR of cases notified (all forms R²=0,96; pulmonary R²=0,98; smear-positive R²=0,95) was observed. The most frequent form is pulmonary with an IR of 29,9/100,000 inhabs in 2007; TB IR in male is twice as in female.   Children below 15 years present the lowest rates (IR= 4,6 in 2007), similar for both genders and with a slightly declining trend in the last years. The male age group of 20-49 years is the most affected, however, the highest rates were seen among patients older than 50 years (81,9 in 2007). As to HIV status, TB patients testing increased and the percentage of positive cases having dropped from 16% in 1998 to 13,2% in 2007. A decline trend was also observed in the co-infected (Tb/HIV), except for the extra-pulmonary forms (all forms R²=0,86; pulmonary R²=0,90; smear-positive R²=0,91).

 Conclusions: There were a significant decline among Tb cases in SPS in the studied period, showing that the actions of TB control in the last 10 years have had a positive effect.