Social determinants of pulmonary tuberculosis in Brazil: an ecological study

Abstract Background Social determinants may influence the incidence and control of tuberculosis (TB). The aim of this study was to evaluate the correlation between social determinants and pulmonary TB (PTB) incidence and treatment outcomes in different regions in Brazil. Methods In this ecological s...

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Main Authors: Alessandra Isabel Zille, Guilherme Loureiro Werneck, Ronir Raggio Luiz, Marcus Barreto Conde
Format: Article
Language:English
Published: BMC 2019-05-01
Series:BMC Pulmonary Medicine
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12890-019-0855-1
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spelling doaj-b72738b12b4c441c8ca276a72c355eed2020-11-25T02:13:43ZengBMCBMC Pulmonary Medicine1471-24662019-05-011911910.1186/s12890-019-0855-1Social determinants of pulmonary tuberculosis in Brazil: an ecological studyAlessandra Isabel Zille0Guilherme Loureiro Werneck1Ronir Raggio Luiz2Marcus Barreto Conde3Instituto de Doenças do Tórax da Universidade Federal do Rio de JaneiroInstituto de Estudos em Saúde Coletiva da Universidade Federal do Rio de JaneiroInstituto de Estudos em Saúde Coletiva da Universidade Federal do Rio de JaneiroInstituto de Doenças do Tórax da Universidade Federal do Rio de JaneiroAbstract Background Social determinants may influence the incidence and control of tuberculosis (TB). The aim of this study was to evaluate the correlation between social determinants and pulmonary TB (PTB) incidence and treatment outcomes in different regions in Brazil. Methods In this ecological study, PTB incidence and treatment outcome rates as well as HIV incidence for all 5560 Brazilian cities as reported to the Brazilian Tuberculosis Program in 2010 were correlated with two social indicators, the Human Development Index (HDI) and Gini Index (GI). Cities were stratified into six groups based on location (metropolitan region or not) and size (small, medium, and large cities), and according to the regions of the country to which they belong. The Spearman correlation coefficient was used to assess the association between variables. Results In 2010, 68,729 new PTB cases were reported in Brazil, with an incidence rate of 36 cases per 100,000 inhabitants. Incidence rates and PTB mortality demonstrated a weak negative correlation with HDI and a positive correlation with GI. The correlation between HDI and GI with cure, relapse, and lost to follow-up of treatment greatly varied in the different groups of cities and regions of the country evaluated. Conclusions There is a weak correlation between HDI and GI and PTB incidence and mortality rate. However, there is great variation between the HDI and GI and cure, relapse, and lost to follow-up in the different groups of cities and regions of the country. This suggests that for TB determination, these outcome variables might be more related to the quality of healthcare provided by services than to social determinants in the general population.http://link.springer.com/article/10.1186/s12890-019-0855-1TuberculosisIncomeInequalitySocial indicators
collection DOAJ
language English
format Article
sources DOAJ
author Alessandra Isabel Zille
Guilherme Loureiro Werneck
Ronir Raggio Luiz
Marcus Barreto Conde
spellingShingle Alessandra Isabel Zille
Guilherme Loureiro Werneck
Ronir Raggio Luiz
Marcus Barreto Conde
Social determinants of pulmonary tuberculosis in Brazil: an ecological study
BMC Pulmonary Medicine
Tuberculosis
Income
Inequality
Social indicators
author_facet Alessandra Isabel Zille
Guilherme Loureiro Werneck
Ronir Raggio Luiz
Marcus Barreto Conde
author_sort Alessandra Isabel Zille
title Social determinants of pulmonary tuberculosis in Brazil: an ecological study
title_short Social determinants of pulmonary tuberculosis in Brazil: an ecological study
title_full Social determinants of pulmonary tuberculosis in Brazil: an ecological study
title_fullStr Social determinants of pulmonary tuberculosis in Brazil: an ecological study
title_full_unstemmed Social determinants of pulmonary tuberculosis in Brazil: an ecological study
title_sort social determinants of pulmonary tuberculosis in brazil: an ecological study
publisher BMC
series BMC Pulmonary Medicine
issn 1471-2466
publishDate 2019-05-01
description Abstract Background Social determinants may influence the incidence and control of tuberculosis (TB). The aim of this study was to evaluate the correlation between social determinants and pulmonary TB (PTB) incidence and treatment outcomes in different regions in Brazil. Methods In this ecological study, PTB incidence and treatment outcome rates as well as HIV incidence for all 5560 Brazilian cities as reported to the Brazilian Tuberculosis Program in 2010 were correlated with two social indicators, the Human Development Index (HDI) and Gini Index (GI). Cities were stratified into six groups based on location (metropolitan region or not) and size (small, medium, and large cities), and according to the regions of the country to which they belong. The Spearman correlation coefficient was used to assess the association between variables. Results In 2010, 68,729 new PTB cases were reported in Brazil, with an incidence rate of 36 cases per 100,000 inhabitants. Incidence rates and PTB mortality demonstrated a weak negative correlation with HDI and a positive correlation with GI. The correlation between HDI and GI with cure, relapse, and lost to follow-up of treatment greatly varied in the different groups of cities and regions of the country evaluated. Conclusions There is a weak correlation between HDI and GI and PTB incidence and mortality rate. However, there is great variation between the HDI and GI and cure, relapse, and lost to follow-up in the different groups of cities and regions of the country. This suggests that for TB determination, these outcome variables might be more related to the quality of healthcare provided by services than to social determinants in the general population.
topic Tuberculosis
Income
Inequality
Social indicators
url http://link.springer.com/article/10.1186/s12890-019-0855-1
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