Educational inequalities in tuberculosis mortality in sixteen European populations

Álvarez, José Luis Domínguez; Kunst, Anton E.; Leinsalu, Mall; Bopp, Matthias; Strand, Bjørn Heine; Menvielle, Gwenn; Lundberg, Olle; Martikainen, Pekka; Deboosere, Patrick; Kalèdiené, Ramuné; Artnik, Barbara; Mackenbach, Johan P.; Richardus, Jan Hendrik

doi:10.5588/ijtld.10.0252

Cited by 38 publications

(33 citation statements)

References 20 publications

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“…There is evidence that deaths have not occurred independently or randomly across territories but tend to cluster in specifi c regions where there is a lack of social support networks and low human and social development (35) (36) .…”

Section: Methodsmentioning

confidence: 99%

Pulmonary tuberculosis in São Luis, State of Maranhão, Brazil: space and space-time risk clusters for death (2008-2012)

Neto

Yamamura

Garcia

et al. 2015

Rev. Soc. Bras. Med. Trop.

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Introduction:The objective was to identify space and space-time risk clusters for the occurrence of deaths in a priority city for the control of tuberculosis (TB) in the Brazilian Northeast. Methods: Ecological research was undertaken in the City of São Luis/ Maranhão. Cases were considered that resulted in deaths in the population living in the urban region of the city with pulmonary TB as the basic cause, between 2008 and 2012. To detect space and space-time clusters of deaths due to pulmonary TB in the census sectors, the spatial analysis scan technique was used. Results: In total, 221 deaths by TB occurred, 193 of which were due to pulmonary TB. Approximately 95% of the cases (n=183) were geocoded. Two signifi cant spatial clusters were identifi ed, the fi rst of which showed a mortality rate of 5.8 deaths per 100,000 inhabitants per year and a high relative risk of 3.87. The second spatial cluster showed a mortality rate of 0.4 deaths per 100,000 inhabitants per year and a low relative risk of 0.10. A signifi cant cluster was observed in the space-time analysis between 11/01/2008 and 04/30/2011, with a mortality rate of 8.10 deaths per 100,000 inhabitants per year and a high relative risk (3.0). Conclusions: The knowledge of priority sites for the occurrence of deaths can support public management to reduce inequities in the access to health services and permit an optimization of the resources and teams in the control of pulmonary TB, providing support for specifi c strategies focused on the most vulnerable populations.Keywords: Pulmonary tuberculosis. Spatio-temporal and spatial analysis. Death.Tuberculosis (TB) is one of the main causes of death among infectious contagious diseases and occurs mainly in developing countries (1) . In 2012, 1.3 million people died of TB worldwide. Brazil ranked 16 th in the number of cases and 109 th in terms of incidence rate(1) , with 36.1 cases per 100,000 inhabitants and a mortality rate of 2.4 deaths per 100,000 inhabitants (2) .It is notable that among the clinical forms of the disease, pulmonary tuberculosis (PTB) is on the list of avoidable causes of death because if the local health services established appropriate health promotion, protection and recovery actions for patients and their families, deaths from TB would be less common (3) .Considered a social disease (4) , TB should be studied from a microregional, local and focal viewpoint, according to the spatial distribution (5) . Therefore, a geo-epidemiological approach to the disease, using geoprocessing techniques, has been adopted in the international sphere (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) . Nevertheless, the introduction of this technology to support the action planning and decision making of health managers and workers is still restricted (18) .In Brazil, a series of studies was undertaken that considered the incidence of the disease and undoubtedly contributed to a better understanding of its dynamics in distinct territories (19) (20) (21) (22) (23) (24) (25) (26) (27) (28) ...

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Section: Methodsmentioning

confidence: 99%

Pulmonary tuberculosis in São Luis, State of Maranhão, Brazil: space and space-time risk clusters for death (2008-2012)

Neto

Yamamura

Garcia

et al. 2015

Rev. Soc. Bras. Med. Trop.

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“…relation through explanatory models of causality [3]. In the study by Alvarez et al [3], an interesting model of TB mortality was presented, incorporating the social inequities into the scope.…”

Section: Pulmonary Tuberculosis;mentioning

confidence: 99%

“…In the study by Alvarez et al [3], an interesting model of TB mortality was presented, incorporating the social inequities into the scope. Nevertheless, it was developed in European countries and did not incorporate the spatial dimension to explain the phenomenon.…”

Section: Pulmonary Tuberculosis;mentioning

confidence: 99%

“…The issue of TB mortality is an object that arouses concern because, from the ethical-human and legal viewpoints, it should not happen because of the available technological resources or inputs. Nevertheless, the organization and distribution logic of the health services does not permit access to all and precisely those who most need them have run out of these resources [3,5].…”

Section: Introductionmentioning

confidence: 99%

“…Although the treatment is feasible and highly effective (95% success rate], TB can be lethal in more than 50% of the cases that cannot be diagnosed or treated [3]. It is important to mention that, around the world, it is estimated that, in 2015, nine million people caught TB, but three million were not detected by the health services, part of them in Brazil [4].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The impact of social inequities on mortality due to pulmonary tuberculosis in São Luis, Maranhão, Brazil

Neto¹,

Yamamura²,

Popolin³

et al. 2016

Int Arch Med

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School life expectancy and risk for tuberculosis in Europe

Machiyama

Semenza

Silverwood

et al. 2015

Int J Public Health

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Objective: This study aims to investigate the effect of country-level school life expectancy on Tuberculosis (TB) incidence to gain further understanding of substantial variation in TB incidence across Europe.Methods: An ecological study examined the prospective association between baseline countrylevel education in 2000 measured by school life expectancy and TB incidence in 2000-2010 in 40 countries of the WHO European region using quantile regression. Subsequently, to validate the ecological associations between education and TB incidence, an individual-level analysis was performed using case-based data in 29 EU/EEA countries from the European Surveillance System (TESSy) and simulating a theoretical control group.Results: The ecological analysis showed that baseline school life expectancy had a negative prospective association with TB incidence. We observed consistent negative effects of school life expectancy on individuals' TB infections prospectively.Conclusions: These findings suggests that country-level education is an important determinant of individual-level TB infection in the region, and in the absence of a social determinants indicator that is routinely collected for reportable infectious diseases, the adoption of countrylevel education for reportable infectious diseases would significantly advance the field.3

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Educational inequalities in tuberculosis mortality in sixteen European populations

Cited by 38 publications

References 20 publications

Pulmonary tuberculosis in São Luis, State of Maranhão, Brazil: space and space-time risk clusters for death (2008-2012)

Pulmonary tuberculosis in São Luis, State of Maranhão, Brazil: space and space-time risk clusters for death (2008-2012)

The impact of social inequities on mortality due to pulmonary tuberculosis in São Luis, Maranhão, Brazil

School life expectancy and risk for tuberculosis in Europe

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