Trend in Tuberculosis Mortality in Salvador (2000–2023): A Joinpoint Regression

After the publication of the National Plan to End Tuberculosis as a Public Health Problem in 2017, measures to evaluate and monitor mortality trends became necessary to ensure health targets are met. In addition, municipalities with high levels of socioeconomic inequality and population density, such as Salvador, may diverge from the national trend, preventing tuberculosis elimination goals from being achieved. Thus, this study aimed to evaluate the trend in tuberculosis mortality in Salvador from 2000 to 2023. This is a time-series study using mortality data from SIM/DATASUS. The study included tuberculosis-related deaths in the municipality of Salvador from 2000 to 2023 (ICD-10: A15–A19), without restriction by sex or age. A joinpoint regression model was applied to evaluate the Annual Percent Change (APC) and Average Annual Percent Change (AAPC). Mortality rates were calculated per 100,000 inhabitants. A 95% confidence interval was used, with significance defined as p<0.05. Analyses were performed using the Joinpoint Regression Program, version 5.4.0 (National Cancer Institute). A total of 2,844 tuberculosis-related deaths occurred in Salvador from 2000 to 2023, with the majority among males (71.5%). Pulmonary tuberculosis accounted for most deaths (93.8%), followed by miliary tuberculosis (2.4%) and tuberculosis of other organs (1.9%). The 50–59-year age group had the highest number of deaths. Joinpoint analysis identified three mortality trends with p<0.05: 2000–2004 showed the greatest decreasing trend (APC -11.5%; CI -22.7 to -6.1), 2004–2020 showed a slight decreasing trend (APC -1.4%; CI -2.6 to -0.3), and 2020–2023 showed an increasing trend (APC 14.9%; CI 3.9 to 33.0). The AAPC for the entire study period was -1.3% (CI -2.4 to -0.4). Despite the interference caused by the pandemic period, it was possible to identify that Salvador experienced phases of more pronounced decline in tuberculosis mortality rates over time and is currently showing an increasing trend, making mortality an important variable for assessing disease magnitude. Therefore, implementation of public policies to reverse this trajectory and improve health indicators is essential.