Excess tuberculosis cases and deaths following an economic recession in Brazil: an analysis of nationally representative disease registry data

Li, Yunfei; Couto, Rodrigo de Macedo; Pelissari, Daniele Maria; Alves, Layana Costa; Bartholomay, Patrícia; Maciel, Ethel Leonor Nóia; Sanchez, Mauro Niskier; Castro, Márcia C.; Cohen, Ted; Menzies, Nicolas A

doi:10.1016/s2214-109x(22)00320-5

Cited by 28 publications

(12 citation statements)

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“…Our findings reveal how the population-level impact of incarceration on tuberculosis has been previously under-recognized by conventional approaches that rely on case notifications within prisons 3,18–21 . Such approaches overlook not only under-detection in prisons but also the highly dynamic nature of incarceration.…”

Section: Discussionmentioning

confidence: 86%

“…By 2019, the average duration of incarceration ranged from 1.3 years (95% UI 0.9-2.1) in Brazil to 6.2 years (4.4-9.0) in El Salvador (Table 1. Further, the percent of the prison population with prior incarceration history ranged from 17% (95% UI [11][12][13][14][15][16][17][18][19][20][21][22] in El Salvador to 51% (39-59) in Brazil. Such differences in incarceration dynamics contribute to the heterogeneity in community prevalence of incarceration history among the population age 15 and older, which ranged from 1.6% (95% UI 1.0-2.3) in Argentina to 7.6% (4.9-10.7) in Mexico (Table 1).…”

Section: Resultsmentioning

confidence: 99%

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Mass incarceration as a driver of the tuberculosis epidemic in Latin America and projected impacts of policy alternatives: A mathematical modeling study

Liu,

Mabene,

Camelo

et al. 2024

Preprint

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Background Tuberculosis incidence is increasing in Latin America, where the incarcerated population has nearly quadrupled since 1990. The full impact of incarceration on the tuberculosis epidemic, accounting for effects beyond prisons, has never been quantified. Methods We calibrated dynamic compartmental transmission models to historical and contemporary data on incarceration and tuberculosis in Argentina, Brazil, Colombia, El Salvador, Mexico, and Peru. Together these countries comprise approximately 80% of the region's incarcerated population and tuberculosis burden. Using historical counterfactual scenarios, we estimated the transmission population attributable fraction (tPAF) for incarceration and the excess population-level burden attributable to increasing incarceration prevalence since 1990. We additionally projected the impact of various incarceration scenarios on future population tuberculosis incidence. Findings The rise in incarceration prevalence since 1990 has resulted in an estimated 30,241 (95% UI, 24,333 - 39,303) excess incident tuberculosis cases in 2019 across the six countries. The tPAF for incarceration in 2019 was 23.5% (95% UI, 17.7-32.0), exceeding estimates for other key risk factors like HIV, alcohol use disorders, and undernutrition. Compared to a base-case scenario where current incarceration policies persist, decarceration interventions could reduce future population tuberculosis incidence in all countries, notably by over 10% in Brazil, Colombia, El Salvador, and Peru. Interpretation The historical rise in incarceration in Latin America has resulted in a large excess burden of tuberculosis that has been under-recognized to-date. International health agencies, ministries of justice, and national tuberculosis programs should collaborate to address this health crisis with comprehensive strategies, including decarceration. Funding National Institutes of Health

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Section: Discussionmentioning

confidence: 86%

Section: Resultsmentioning

confidence: 99%

Mass incarceration as a driver of the tuberculosis epidemic in Latin America and projected impacts of policy alternatives: A mathematical modeling study

Liu,

Mabene,

Camelo

et al. 2024

Preprint

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“…As in technical progress, where solutions were never perfect the first time: let's remember the first cars that we can still see in a movie of the time: the decisive thing was that they were already moving; but let's compare them with one of our current cars and we will see how much we have improved this new transport system: rear-view mirrors, more comfortable seats, faster speed to that of thirty years ago, at least in many cases). It is not about having a replacement to apply, but about taking steps in the direction of health (Li et al, 2022).…”

Section: Figure 1 Philippines Manufacturing Pmimentioning

confidence: 99%

Food Crisis, Energy Crisis and Recession: A Global Opportunity and Challenge towards Endemic

Grandea

2022

IJSOC

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The purpose of this study is to analyze the energy crisis, food and recession as a challenge and opportunity in the global world towards endemic. This research uses qualitative research with descriptive analysis approach. The types of data used in this study are primary data and secondary data. Presentation of data using qualitative methods. This study shows that the disappearance of a system based on the free play of market players supported by weak regulatory management has been marked by the massive paralysis of private investment in the energy and food sectors on a global scale, particularly gas and electricity. The effect is yet to be seen due to a significant economic recession, but it is unknown to experts that in 2023 there will be a recession. The recent economic recovery has led to an increase in energy demand and the first effects of the crisis are imminent, this of course due to the protracted war between Russia and Ukraine. The current government is late in reacting to problems that have structural characteristics that are impossible to solve in the short term.

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“…In Brazil, TB diagnosis and treatment is provided through the universal healthcare system, Sistema Único de Saúde (SUS), under which TB incidence and mortality have decreased over time [5]. However, this decline stalled following an economic crisis in 2014 [6] and TB mortality was estimated as 3.3 per 100,000 in 2019 [7, 8]. During the COVID-19 pandemic, the national TB program reported an increase in loss to follow-up, which in 2020 rose to 12% of treated individuals, and has also experienced decreasing rates of participation in directly observed therapy (DOT) [5].…”

Section: Introductionmentioning

confidence: 99%

Predictors of unsuccessful tuberculosis treatment outcomes in Brazil: an analysis of 259,484 patient records

Ryuk,

Pelissari,

Alves

et al. 2024

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IntroductionTuberculosis (TB) causes over 1 million deaths annually. Providing effective treatment is a key strategy for reducing TB deaths. In this study, we identified factors associated with unsuccessful treatment outcomes among individuals treated for TB in Brazil.MethodsWe obtained data on individuals treated for TB between 2015 and 2018 from Brazil’s National Disease Notification System (SINAN). We excluded patients with a history of prior TB disease or with diagnosed TB drug resistance. We extracted information on patient-level factors potentially associated with successful treatment, including demographic and social factors, comorbid health conditions, health-related behaviors, health system level at which care was provided, use of directly observed therapy (DOT), and clinical examination results. We categorized treatment outcomes as successful (cure, completed) or unsuccessful (death, regimen failure, loss to follow-up). We fit multivariate logistic regression models to identify factors associated with unsuccessful treatment outcome.ResultsAmong 259,484 individuals treated for drug susceptible TB, 19.7% experienced an unsuccessful treatment outcome (death during treatment 7.8%, regimen failure 0.1%, loss to follow-up 11.9%). The odds of unsuccessful outcome were higher with older age (adjusted odds ratio (aOR) 2.90 [95% confidence interval: 2.62–3.21] for 85-100-year-olds vs. 25-34-year-olds), male sex (aOR 1.28 [1.25– 1.32], vs. female sex), Black race (aOR 1.23 [1.19–1.28], vs. White race), no education (aOR 2.03 [1.91– 2.17], vs. complete high school education), HIV infection (aOR 2.72 [2.63–2.81], vs. no HIV infection), illicit drug use (aOR 1.95 [1.88–2.01], vs. no illicit drug use), alcohol consumption (aOR 1.46 [1.41– 1.50], vs. no alcohol consumption), smoking (aOR 1.20 [1.16–1.23], vs. non-smoking), homelessness (aOR 3.12 [2.95–3.31], vs. no homelessness), and immigrant status (aOR 1.27 [1.11–1.45], vs. non-immigrants). Treatment was more likely to be unsuccessful for individuals treated in tertiary care (aOR 2.20 [2.14–2.27], vs. primary care), and for patients not receiving DOT (aOR 2.35 [2.29–2.41], vs. receiving DOT).ConclusionThe risk of unsuccessful TB treatment varied systematically according to individual and service-related factors. Concentrating clinical attention on individuals with a high risk of poor treatment outcomes could improve the overall effectiveness of TB treatment in Brazil.

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Excess tuberculosis cases and deaths following an economic recession in Brazil: an analysis of nationally representative disease registry data

Cited by 28 publications

References 30 publications

Mass incarceration as a driver of the tuberculosis epidemic in Latin America and projected impacts of policy alternatives: A mathematical modeling study

Mass incarceration as a driver of the tuberculosis epidemic in Latin America and projected impacts of policy alternatives: A mathematical modeling study

Food Crisis, Energy Crisis and Recession: A Global Opportunity and Challenge towards Endemic

Predictors of unsuccessful tuberculosis treatment outcomes in Brazil: an analysis of 259,484 patient records

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