The Burden of Alcohol, Tobacco and Others Drugs Among Prisoners Diagnosed With Tuberculosis: Time Trends and Spatial Determinants in Southern Brazil

Abstract

Background Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis and is a public health problem worldwide. It is estimated that 90% of the patients diagnosed with TB live in vulnerable environments with limited health resources, such as individuals living in correctional facilities. This study aimed to identify the consumption of alcohol, tobacco, and other drugs among prisoners diagnosed with tuberculosis and the spatial determinants and time trends of the phenomenon in southern Brazil. Methods An ecological study using data from the Brazilian Notifiable Diseases Information System. Tuberculosis cases confirmed from 2014 to 2018 in prisons located in Paraná, Brazil, were selected. The Prais-Winsten procedure was performed to identify time trends by calculating monthly rates and the percentage of monthly variation. The Seasonal-Trend by Loess decomposition method was used to verify the time series and trends. The spatial association was verified with the Getis-Ord Gi* technique, and risk areas were identified using spatial scan statistics. Results A total of 1,099 TB cases were found in the studied population. The consumption of tobacco (n = 460; 41.9%), illegal drugs (n = 451; 41.0%), and alcohol (n = 179; 16.3%) stand out. An ascending trend was found for the consumption of alcohol [+ 19.4%/mo. (95%CI: 12.20-23.03)], tobacco [+ 20.2% (95%CI: 12.20-28.82)], and illegal drugs [+ 62.2%/mo. (95%CI: 44.54–81.97)]. Spatial analysis revealed clusters for the use of alcohol, tobacco, and illegal drugs. Conclusions This study advances knowledge presenting the burden of drug use and its typology among individuals diagnosed with tuberculosis in the prison system. There is a growing trend among patients to use drugs, especially illegal drugs. The clusters show differences between the places where the prisons are located. Tuberculosis within the prison system is already a complex disease, and it is even more challenging when drugs are consumed. The consumption of drugs increased threefold when tobacco and alcohol were considered.