TRENDS IN TUBERCULOSIS HOSPITALIZATIONS IN BRAZIL BEFORE, DURING, AND AFTER THE COVID-19 PANDEMIC: DESCRIPTIVE ECOLOGICAL STUDY

Abstract

Tuberculosis (TB) remains one of the leading causes of death from infectious diseases worldwide, especially in low- and middle-income countries. In Brazil, 68,271 new cases were reported in 2021, with an incidence of 32 cases per 100,000 inhabitants. In 2020, there were 4,543 deaths from TB, corresponding to a mortality rate of 2.1 per 100,000 inhabitants. The COVID-19 pandemic directly impacted the diagnosis and treatment of chronic and infectious diseases. This study aimed to analyze trends in hospitalizations for pulmonary TB in Brazil. Observational, ecological, retrospective study using secondary data from the Brazilian Hospital Information System (SIH/SUS), obtained from DATASUS. All hospitalizations for pulmonary TB (ICD-10 A15.0) between 2018 and 2024 were included, without restriction by sex, age, or region. Years were grouped into three periods: pre-pandemic (2018–2019), pandemic (2020–2021), and post-pandemic (2022–2024). The annual mean number of hospitalizations was calculated for each period. Statistical comparison between groups was performed using the Kruskal-Wallis test, with a 5% significance level (p<0.05). Mean annual hospitalizations for pulmonary TB were 5,641.5 in the pre-pandemic period, 8,884.5 during the pandemic, and 11,230.3 in the post-pandemic period. Although data show an upward trend in hospitalizations, the Kruskal-Wallis test did not demonstrate statistically significant differences between periods (H = 3.18; p=0.204). Despite the lack of statistically significant differences between periods, the data suggest an increasing trend in hospitalizations for pulmonary TB after the pandemic. Disruptions in health services during COVID-19, resource reallocation, and patients’ hesitation to seek care may have contributed to diagnostic delays and more severe cases. Continued monitoring is essential to assess indirect effects of the pandemic and to plan control strategies focusing on early diagnosis and access to treatment.