Mortalidade e carga de tuberculose atribuível ao consumo do álcool no Brasil e macrorregiões entre 2000 e 2017 – estudo GBD Brasil

Abstract

Although known to be a risk factor for noncommunicable diseases, alcoholic beverages consumption plays an important role in the burden of communicable diseases, especially tuberculosis. Advances in surveillance and health care are notable, but the disease remains a public health problem in Brazil and worldwide, where more than one million people die each year from tuberculosis. The present study aimed to describe the burden of tuberculosis attributable to alcohol consumption (TBAA) in Brazil and macro-regions between 2000 and 2017. We calculated total deaths, years lived with disabilities (YLD), years of life lost (YLL), years of life lost adjusted by death or disability (DALY = YLL + YLD), mortality rate and DALY rate by TBAA in Brazil between 2000 and 2017, as well as alcohol attributable fraction (%) among DALY and deaths by tuberculosis in Brazil in 2017. Estimates from the Global Burden of Disease (GBD) study were used as a data source, also stratified by states, macro-regions, sex and age group (15 to 29, 30 to 69 and 70 years or more). According to GBD estimates, 51,250 people died, and 1,912,353 healthy years of life were lost due to TBAA-related deaths or disabilities (DALY) in Brazil between 2000 and 2017. In this period, the annual number of deaths and DALY per TBAA, as well as the mortality rate and DALY by TBAA reduced, respectively, 26%, 29%, 54.2% and 52.8%. YLL was the main component in DALY by TBAA (> 95%). Among states, Pernambuco (2.1/100,000 inhabitants) and the Federal District (0.35/100,000 inhabitants) showed, respectively, the highest and lowest mortality rate and DALY in 2017, while São Paulo (490 deaths; 17,895 DALY) and Roraima (5 deaths, 204 DALY), the highest and lowest absolute number. In Brazil and in the five macro-regions, mortality rates and DALY by TBAA generally maintained a negative average annual variation over the study period, with greater magnitude in Northeast Region and exceptions in recent years. For each death due to TBAA in women, 6 deaths in men were estimated, while for DALY the ratio was 5.2 years lost. Both female population and male population showed a gradient in mortality rate due to TBAA according to age group, with youngest presenting smallest and the oldest presenting highest rates throughout entire historical series. The burden of TBAA in elderly population (70 or more), however, was lower than in adult population (30 to 69) for both sexes throughout the entire historical series. It was estimated that 45.5% of deaths and 47.5% of TB burden in the country in 2017 were attributable to alcohol consumption. Obstacles remain challenges to be faced in interrupting chain transmission and in reaching national and global TB reduction goals. Integrated measures for the surveillance and control of disease and alcohol as a risk factor are necessary, including actions aimed at individual and collective level.