Estimation of tuberculosis mortality burden in Spain: a review of the major data sources.

Introduction: In Spain, notifications of cases of tuberculosis (TB) are registered through the National Epidemiological Surveillance Network (RENAVE). The Minimum Basic Data Set (CMBD) provides information on hospital discharge and the National Statistics Institute (INE) draws on medical death certificates. This study aimed to describe TB mortality in Spain and to compare estimates across data sources, as well as with EU/EEA countries.

Material And Methods: A retrospective study of TB data between 2008 and 2021 was performed. Mortality rates (MRs) were calculated for the three databases as well as case fatality rates (CFRs) for TB location and HIV status using RENAVE data. Time trends were calculated and the mean MR and annual mean percentage change for Spain were compared with EU/EEA countries.

Results: Between 2008 and 2021, 4127 TB deaths were reported to RENAVE, 3877 to INE and 4775 to CMBD. The MR was 0.62 per 100 000 inhabitants for RENAVE, 0.59 for INE and 0.72 for CMBD. A statistically significant downward annual trend was observed. Highest MRs across all databases were found in men and in those over 80 years old. CFR was higher for meningeal TB and for HIV patients with a risk ratio of 2.02 (95% CI 1.82-2.2; p<0.05).

Conclusion: Although the TB MR in Spain has followed a downward annual trend, it is necessary to continue improving prevention, diagnosis and treatment. This will require comprehensive measurement, better knowledge and better use of all information to complement surveillance systems.