Nature Medicine | Long-term risk of death after tuberculosis diagnosis and treatment
Nature Medicine | Long-term risk of death after tuberculosis diagnosis and treatment
Thiago Cerqueira-Silva, Viviane Sampaio Boaventura, Enny S. Paixão, Mauro Sanchez, Clémence Leyrat, Otavio Ranzani, Mauricio L. Barreto & Julia M. Pescarini
DOI: https://doi.org/10.1038/s41591-026-04294-w
Background
Tuberculosis (TB) remains a major societal burden, yet data on long-term mortality following TB diagnosis and treatment are limited.
Methods
A nationwide Brazilian cohort study using linked data (2004–2018) was conducted to quantify long-term mortality (up to 14 years) following TB. Individuals diagnosed with TB and individuals who had completed TB treatment were matched to TB-free individuals. Competing risk methods were used to analyze natural causes (defined as deaths excluding TB, HIV and external causes) and cause-specific mortality.
Fig. 1 Study flowchart
Results
In the diagnosed cohort (185,921 pairs), the risk of 14-year natural cause mortality was significantly higher (risk ratio (RR) = 2.16, 95% confidence interval = 1.96–2.37); RRs were significantly elevated for deaths due to cancer, cardiovascular, endocrine, respiratory and external causes. In the treated cohort (111,871 pairs), natural cause mortality risk remained elevated (RR = 1.77, 95% confidence interval = 1.55–2.03), with similarly increased RRs across specific causes.
Fig. 2 Yearly IRRs for deaths due to natural causes
Fig. 3 Cause-specific risk of death of patients with diagnosed and treated TB
Fig. 4 Stratified analysis for the treated TB-exposed group
Conclusion
TB survivors, even after treatment, face a significantly elevated and prolonged risk of death from multiple causes up to 14 years later, highlighting the need for long-term monitoring to reduce the burden of TB.
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