Risk of Death From Pulmonary Tuberculosis Attributable to Diabetes Mellitus in Brazil: A Retrospective Cohort Study of Health Surveillance Data

BACKGROUND: Diabetes mellitus (DM) is associated with increased susceptibility to tuberculosis (TB) and unfavorable treatment outcomes. OBJECTIVE: To evaluate the risk of pulmonary tuberculosis (PT)-related mortality attributable to DM in Brazil and to identify subgroups that may require differentiated clinical management. METHODS: Descriptive and retrospective cohort study using data from Brazil's national health surveillance system. Data on new PT cases in individuals aged ≥18 years, diagnosed between 2012 and 2017, were analyzed. Fatality rates were compared between patients with and without self-reported DM, stratified by relevant covariates, to estimate the attributable risk due to DM (ARDM%). RESULTS: A total of 355,659 patients with PT were included in the analysis of this study, of whom 29,579 (8.3%) had PT-DM, and 326,080 (91.7%) had PT alone, without DM. Patients with PT-DM exhibited higher PT fatality rates (1,691, 5.7%) and lower treatment discontinuation rates (2,425, 8.2%) than those without DM (12,203, 3.7%) or who completed the full course of treatment (50,216, 15.4%). Overall, DM accounted for a 34.6% increase in PT fatality (ARDM%). The highest ARDM% (>50%) was observed among patients with higher education levels, those aged 18-39 years, residents of peri-urban areas, recipients of the Brazilian Cash Transfer Program (BCTP), and incarcerated individuals. CONCLUSIONS: DM substantially increases the fatality rate among patients with PT in Brazil, particularly in specific subgroups that may benefit from targeted clinical and public health interventions.