The Temporal Trends of Mortality Due to Tuberculosis in Brazil: Tracing the Coronavirus Disease 2019 (COVID-19) Pandemic's Effect Through a Bayesian Approach and Unmasking Disparities.

The COVID-19 pandemic disrupted tuberculosis (TB) control, increasing mortality and potentially worsening disparities. This study aimed to analyze the temporal trends of TB mortality in Brazil and to trace the COVID-19 pandemic's effect using a Bayesian approach, focusing on nationwide data. An ecological study of TB deaths recorded in the Mortality Information System (SIM) from 2012 to 2022 was conducted. Trends and percentage changes in the mortality were estimated. A Bayesian Structural Time Series model combined with an Autoregressive Integrated Moving Average model was used to assess the pandemic's effect on TB. A total of 51,809 TB deaths were identified, with a mortality rate of 2.27 per 100,000. Higher rates were found among the elderly (6.86), indigenous populations (5.58), and black individuals (4.21). The Bayesian model estimated a 9.9% (CI 8.8-11%) increase in TB mortality due to COVID-19. The Midwest region showed the highest increase (30%, 25-35%). Females experienced a greater post-pandemic monthly increase (2.80%) in mortality than males (0.72%). The Bayesian analysis revealed a significant rise in TB mortality during the COVID-19 pandemic, with notable disparities affecting females, the elderly, the indigenous, and the black populations. These findings highlight the pandemic's long-term impact on TB and stress the need for equity-focused, data-driven public health responses in Brazil.