Differential outcomes of tuberculosis hospitalizations in Ecuador: Lower pediatric mortality compared with adults

<h2>Abstract</h2><h3>Problem considered</h3> This study aimed to assess tuberculosis hospitalizations and in‐hospital mortality in Ecuador (2015-2023), while identifying factors associated with mortality. <h3>Methods</h3> We conducted a cross-sectional study using the Statistical Registry of Hospital Beds and Discharges of the Ecuadorian National Institute of Statistics and Censuses (INEC). Cases with International Classification of Diseases 10th Revision (ICD-10) codes A15–A19 were included. Hospitalization and mortality rates were estimated by year and province. Univariable and multivariable logistic regression models were used to identify factors associated with mortality. <h3>Results</h3> 17,724 tuberculosis hospitalizations were analyzed, 2,955 (16.67%) were pediatric patients, 14,769 (83.33%) were adults. Adults showed higher proportion of deaths (10.31%) than children (1.83%). Tuberculosis of lung was the most frequent type in both children and adults (n=11,284; 63.67%). Guayas, Napo, and Santo Domingo provinces had the highest hospitalizations and mortality rates; Napo showing highest hospitalization rate among children. Although severe forms disproportionately affected pediatric mortality, pediatric ages showed lower death probabilities compared to adults. Notably, when analyzing only pediatric cases, children under 15 years showed lower probabilities of death compared to those aged 15-19 years. During 2020, hospitalization rates declined, with subsequent rebound in 2022–2023. <h3>Conclusion</h3> Adults bear significantly higher tuberculosis burden than children. However, severe tuberculosis forms showed higher impact on pediatric mortality, underscoring the need for improved protocols for children. Nevertheless, protective effects in ages under 15 years, might reflect benefits of Ecuador's mandatory neonatal BCG vaccination and prioritized pediatric care, although persistent underdiagnosis challenges in children might also shape the observed patterns.