Tuberculose em pessoas idosas: análise de fatores associados, tendências temporais e revisão de evidências científicas

Abstract

Introduction: Tuberculosis (TB), despite being an ancient disease, remains a significant public health concern in Brazil and worldwide. It is caused by infection with Mycobacterium tuberculosis, also known as the Koch bacillus, and primarily affects the lungs, though it may also involve other organs. Old person are more susceptible to developing the disease due to the weakening of organ systems inherent to the aging process (senescence). Objective: To analyze the associated factors, temporal trends, and scientific evidence regarding TB in older adults. Methodology: To achieve the proposed objectives, three research products were developed. (1) A descriptive, retrospective ecological study with a quantitative, cross-sectional design was conducted to analyze the temporal trends (TT) of TB incidence (TI) and mortality (TM) rates among older adults in the Brazilian Northeast between 2012 and 2022. Data were collected from the Department of Informatics of the Brazilian Unified Health System (DATASUS), and TT was assessed using the Prais-Winsten generalized linear regression model, which accounts for first-order autocorrelation (AR1). (2) A scoping review protocol was designed to identify the main factors associated with pulmonary tuberculosis (PTB) in older adults. The protocol followed the Joanna Briggs Institute (JBI) guidelines for this type of review and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR). It was registered with the Open Science Framework (OSF). (3) The final product is a scoping review, aimed at rigorously and transparently mapping the state of the art on the key factors associated with PTB in older adults. Results: Article (1) demonstrated that both incidence and mortality rates were higher among males, individuals aged 60 to 69, and those of mixed race/color. An increase in the Annual Percent Change (APC) in incidence was observed among females in the state of Pernambuco. Article (2), the scoping review protocol, provided the methodological foundation for the development of the review itself. Article (3), the resulting scoping review, revealed that PTB in older adults is influenced by multifactorial determinants, including male sex, pre-existing diabetes mellitus, tobacco use, and close contact with individuals with active TB. Final Considerations: By analyzing associated factors, temporal trends, and scientific evidence, this research revealed epidemiological, clinical, and social vulnerabilities related to TB in older adults, the three products developed underscore the urgent need for targeted public policies, strengthened epidemiological surveillance, and intersectoral approaches. The findings contribute to the development of more effective strategies for prevention, diagnosis, and management of TB in the elderly population, ultimately promoting healthier and more equitable aging.