RACIAL INEQUALITIES IN TUBERCULOSIS MORTALITY IN BRAZIL: TIME-TREND ANALYSIS AND THE IMPACT OF THE COVID-19 PANDEMIC, 2010–2023

Tuberculosis (TB) remains an important public health problem in Brazil, disproportionately affecting socially vulnerable populations. This study analyzes time trends in TB mortality by race/color, highlighting persistent racial inequities in the country. Ecological time-series study using Mortality Information System data (SIM/DATASUS) from 2010 to 2023. TB-related deaths (ICD-10: A15–A19 and B90) listed in any field of the Death Certificate were included. Race/color was analyzed in six categories: White, Black, Mixed-race, Asian, Indigenous, and Unknown. Linear and polynomial regression analyses were applied to evaluate time trends, the Mann-Kendall test was used to assess statistical significance, and joinpoint analysis was used to identify changes in trends, especially during the pandemic period. A total of 93,379 TB-related deaths were recorded over the period. Mortality among the Black population increased significantly during the pandemic: Black individuals showed the largest relative increase (+25.6%; p<0.0001), rising from 74.81 to 93.93 deaths/month. Mixed-race individuals, with the highest absolute burden, increased by 19.9% (259.19 to 310.89 deaths/month; p<0.0001). Both groups showed significant increasing trends (Mann-Kendall p<0.001). Among Indigenous people, mortality increased by 17.7% (p=0.0485), while among White people there was a 7.7% increase (p=0.0004). Records with missing race/color decreased by 44.5%, indicating improved data completeness. The results show a worsening of racial inequalities in TB mortality, with a disproportionate impact on the Black population. Improved completion of race/color (reduction in “unknown” records) enables more accurate analyses of inequities. The COVID-19 pandemic intensified preexisting disparities, suggesting greater vulnerability of the Black population to social determinants of health. TB mortality in Brazil shows marked and increasing racial inequalities, exacerbated during the pandemic. These findings reinforce the urgency of targeted public policies that recognize racism as a social determinant of health, aligned with the National Policy for Comprehensive Health of the Black Population and the Sustainable Development Goals for TB reduction by 2030.