How do social-economic differences in urban areas affect tuberculosis mortality in a city in the tri-border region of Brazil, Paraguay and Argentina

Abstract

BackgroundThe World Health Organization (WHO) launched the “End TB Strategy”, which aims to reduce tuberculosis (TB) mortality by 95% by 2035, Brazil has made a commitment to this, however, one challenge is achieving the goal in the border region, where the TB situation is more critical. The proposal was to analyse the spatial mortality due to TB and its socio-economic determinants in the general population, around the border areas of Brazil, Paraguay and Argentina, as well as the temporal trend in this region.MethodThis ecological study considered the cases of TB deaths of residents of Foz do Iguaçu (BR), with its units of analysis being the census sectors. The standardized mortality rate was calculated for each area. Socioeconomic variables data were obtained from the 2010 Demographic Census of the Brazilian Institute of Geography and Statistics (IBGE). The scan statistic was applied to calculate the spatial relative risk (RR), considering a 95% confidence interval (CI). Spatial dependence was analysed using the Global Bivariate Moran I and Local Bivariate Moran I (LISA) to test the relationship between the socioeconomic conditions of the urban areas and mortality from TB. Analysis of the temporal trend was also performed using the Prais-Winsten test.ResultsA total of 74 cases of TB death were identified, of which 53 (71.6%) were male and 51 (68.9%) people of white skin colour. The mortality rate ranged from 0.28 to 22.75 cases per 100,000 inhabitants. A spatial relative risk area was identified, RR = 5.07 (95% CI 1.79–14.30). Mortality was associated with: proportion of people of brown skin colour (I: 0.0440, p = 0.033), income (low income I: − 0.0611, p = 0.002; high income I: − 0.0449, p = 0.026) and density of residents (3 and 4 residents, I: 0.0537, p = 0.007; 10 or more residents, I: − 0.0390, p = 0.035). There was an increase in the mortality rate in people of brown skin colour (6.1%; 95% CI = 0.029, 0.093).ConclusionDeath due to TB was associated with income, race resident density and social conditions. Although the TB mortality rate is stationary in the general population, it is increasing among people of brown skin colour.

Determinants associated with areas with higher tuberculosis mortality rates: an ecological study

“…Mean TB incidence rate, percentage of HIV testing among those diagnosed with TB, the proportion of the population aged 18 years or more without complete primary education and in informal occupations, and the proportion of the population living in urban households without waste collection are related to areas with a high mortality rate due to tuberculosis. These results are consistent with previous studies . TB presents a good approximation of social determinants of a municipality or country, since it is influenced by the processes of social reproduction; therefore, it worries health authorities around the world .…”

“…Combined with individual characteristics, they are also an important risk contributor to TB mortality [22]. The prevalent characteristics of TB mortality in our socio-demographic profile were male sex, mixed-race, age between 40 and 59 years, and low educational attainment-corroborating investigations around the world [9,13,23]. New strategies that improve the quality of life of the population with TB and reduce the number of cases that abandon treatment, as well as the number of recurrences of TB and deaths from TB, are fundamental to morbidity and mortality control [24].…”

“…Educational level is an important predictor of increase in mortality rates due to TB . In our study, municipalities with a lower percentage of the population aged 18 years or more without complete primary education and in informal occupations were the ones that are more likely to increase their TB mortality rate.…”

“…The bivariate relationships of areas with high TB mortality rate with the mean TB incidence rate, the percentage of HIV testing in TB patients and the percentage of the population living in urban households without waste collection services were statistically significant. High TB mortality rates in municipalities and countries are associated with income inequality, the density of residents in the households and the social conditions in which they live and to which they are exposed .…”

Os determinantes da mortalidade por Tuberculose e TB-HIV no Sul do Brasil: Da abordagem espacial à análise de sobrevida

“…Ao se analisar a mortalidade por TB, levando em conta o espaço, é possível diagnosticar indicadores sociais relacionados, além de expor áreas com maior vulnerabilidade social atrelada ao desfecho, o que permite definição de ações de reestruturação na saúde e dos territórios (ARCOVERDE et al, 2018;BERRA et al, 2017;SANTOS et al, 2018) A análise espacial dos óbitos por TB permite um aprimoramento de ações de vigilância dos casos, além de revelar a acessibilidade aos serviços de saúde para diagnóstico precoce e acompanhamento dos casos já diagnosticados nos diferentes pontos de atenção; desta forma, verifica-se o comportamento da doença em meio a uma determinada população e se avalia se as intervenções em saúde já praticadas são efetivas (PINA; SANTOS, 2000).…”