Areas with evidence of equity and their progress on mortality from tuberculosis in an endemic municipality of southeast Brazil

Author(s):Show less -

Yamamura, Mellina ^[1] ; Santos Neto, Marcelino ^[2] ; Chiaravalloti Neto, Francisco ^[3] ; Arroyo, Luiz Henrique ^[1] ; Vieira Ramos, Antonio Carlos ^[1] ; Rego de Queiroz, Ana Angelica ^[1] ; Belchior, Aylana de Souza ^[1] ; dos Santos, Danielle Talita ^[1] ; Crispim, Juliane de Almeida ^[1] ; Pinto, Ione Carvalho ^[1] ; da Costa Uchoa, Severina Alice ^[4] ; Fiorati, Regina Celia ^[5] ; Arcencio, Ricardo Alexandre ^[1]

Affiliation

^[1] Univ Sao Paulo, Sch Nursing, Ribeirao Preto Campus EERP USP, Ribeirao Reto, SP - Brazil

^[2] Fed Univ Maranhao UFMA, Sao Luis, MA - Brazil

^[3] Univ Sao Paulo FSP USP, Sch Publ Hlth, Sao Paulo, SP - Brazil

^[4] Fed Univ Rio Grande Norte UFRN, Natal, RN - Brazil

^[5] Univ Sao Paulo, Sch Med, Ribeirao Preto Campus FMRP USP, Ribeirao Preto, SP - Brazil

• Document type: Journal article
• Source: INFECTIOUS DISEASES OF POVERTY; v. 6, OCT 12 2017.
• Web of Science Citations: 2

Abstract

Background: In Brazil, people still fall ill and die from tuberculosis (TB), and this can be explained by the significant impasse in the equity of distribution of therapeutic resources to the population as a whole. The aim was to identify geographical areas which have shown progress in terms of equity (of income, schooling and urban occupancy) and test its effect on mortality from TB in a municipality of southeast Brazil. Methods: It is an ecological study considering TB as the basic cause for deaths registered between 2006 and 2013 on the Mortality Information System and other variables obtained through the Demographic Census of the Brazilian Institute of Geography and Statistics (2010). The geographical area for analysis comprised the areas of coverage of the health services. Social indicators have been constructed through the Principal Component Analysis (PCA). The cases were geocoded and the annual mortality rate from TB was calculated with smoothing using the local empirical Bayesian method. Multiple linear regression was then performed. There was confirmation of the existence of spatial dependence of residue through the application of the Global Moran I test, and application of the Models with Global Spatial Effects, to identify the best standard of spatial regression. Results: The mortality rates ranged from 0.00 to 2.8 deaths per 100,000 people, per year. In the PCA, three indicators were constructed, and designated as indicators of income, social inequality, and social equity. In multiple linear regression, the indicator of social equity was statistically significant (P < 0.0001) but had a negative association, an adjusted R-2 of 28.36% and with spatial dependence (Moran I = 0.21, P = 0.003455). The best model to deal with existing spatial dependence was the Spatial Lag Model. Conclusions: The better social conditions have shown progress in reducing mortality from TB, thereby reinforcing the achievement of Sustainable Development Goals. In addition, cartography was also applied, which can be replicated in other scenarios throughout the world, using a scope distinct from that of works traditionally produced in that it places the emphasis on social equity. (AU)

• FAPESP's process: 11/22834-5 - Mortality, hospitalizations for tuberculosis and underreporting of cases in Ribeirão Preto (SP)
• Grantee: Mellina Yamamura Calori
• Support Opportunities: Scholarships in Brazil - Doctorate
• FAPESP's process: 15/17586-3 - Mortality from tuberculosis and its relationship with social inequalities : a multicenter study
• Grantee: Ricardo Alexandre Arcêncio
• Support Opportunities: Regular Research Grants