Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, United Kingdom
V.R. Peixoto
NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal; Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal
J.A. Caylà
Foundation of Tuberculosis Research Unit of Barcelona, Spain
M.D. Gomes
EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal; National Tuberculosis Programme, Directorate-General of Health, Lisbon, Portugal
S. Sousa
National Tuberculosis Programme, Directorate-General of Health, Lisbon, Portugal; Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
R. Duarte
EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal; Public Health Science and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal; Pulmonology Department, Hospital Centre of Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal
I. Carvalho
National Tuberculosis Programme, Directorate-General of Health, Lisbon, Portugal; Pediatric Department, Hospital Centre of Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal
C. Carvalho
Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal; Corresponding author.
Background: Tuberculosis (TB) incidence declined in Portugal in recent decades, but trends differ between regions and population subgroups. We investigated these differences to inform prevention and control programmes. Methods: We extracted TB notifications from the Portuguese National TB Surveillance System (SVIG-TB) in 2010–2017, disaggregated by region, age group, nationality and HIV status. We calculated notification rates using denominators from the Portuguese National Institute of Statistics and the Joint United Nations Programme on HIV/AIDS and performed stratified time series analysis. We estimated interannual decline percentages and 95% confidence intervals (CI) using Poisson and binomial negative regression models. Results: The overall TB notification rate decreased from 25.7 to 17.5/100,000 population from 2010 to 2017 (5.2%/year) in Portugal. Interannual decline did not differ significantly between regions, but it was smaller amongst non-Portuguese nationals (-1.57% [CI: -4.79%, 1.75%] vs -5.85% [CI: -6.98%, -4.70%] in Portuguese nationals); children under five years of age (+1.77% [CI: -4.61%, 8.58%] vs -5.38% [CI: -6.33%, -4.42%] in other age groups); and HIV-negative people (-6.47% [CI: -9.10%, -3.77%] vs -11.29% [CI; -17.51%, -4.60%] in HIV-positive). Conclusions: The decline in TB notification rates in Portugal during the study period has been steady. However, the decline amongst non-Portuguese nationals, children under five years of age and non-infected-HIV patients was lower. No significant differences were observed between regions. Changes in TB epidemiology in specific risk groups and geographical areas should be closely monitored to achieve the objectives of the End TB Strategy. We recommend intensifying screening of TB in the subpopulations identified.
