Social risk and its association with tuberculosis mortality in a context of high inequality in South Brazil: A geo-epidemiology analysis

Autor(es)

dos Santos, Danielle Talita ^{[1, 2]} ; Alves, Luana Seles ^[1] ; Moraes Arcoverde, Marcos Augusto ^[1] ; Arroyo, Luiz Henrique ^[1] ; Berra, Thais Zamboni ^[1] ; Vieira Ramos, Antonio Carlos ^[1] ; dos Santos, Felipe Lima ^[1] ; Arcencio, Ricardo Alexandre ^[1] ; Nunes, Carla ^{[2, 3]}

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Ribeirao Preto Coll Nursing, Ribeirao Preto Campus EERP USP, Ave Bandeirantes, BR-14040902 Ribeirao Preto, SP - Brazil

^[2] Univ NOVA Lisboa, NOVA Natl Sch Publ Hlth, Ave Padre Cruz, P-1600560 Lisbon - Portugal

^[3] Univ NOVA Lisboa, Publ Hlth Res Ctr, Ave Padre Cruz, P-1600560 Lisbon - Portugal

• Tipo de documento: Artigo Científico
• Fonte: JOURNAL OF INFECTION AND PUBLIC HEALTH; v. 13, n. 8, p. 1148-1155, AUG 2020.
• Citações Web of Science: 0

Resumo

Background: Tuberculosis (TB) is one of the top 10 causes of death worldwide; in 2016, over 95% of TB deaths occurred in low- and middle-income countries. Although the incidence and deaths from TB have decreased in Brazil in recent years, the disease has increased in the vulnerable population, whose diagnosis is more delayed and the chances for abandonment and deaths are significantly higher. This study aimed to identify high-risk areas for TB mortality and evidence their social determinants through a sensitive tailored social index, in a context of high inequality in South Brazil. Methods: A multistep statistical methodology was developed, based on spatial clustering, categorical principal components analysis, and receiver operating characteristic curves (ROC). This study considered 138 spatial units in Curitiba, South Brazil. TB deaths (2008-2015) were obtained from the National Information Mortality System and social variables from the Brazilian Human Development Atlas (2013). Results: There were 128 TB deaths recorded in the study: the mortality rate was 0.9/100,000 inhabitants, minimum-maximum: 0-25.51/100,000, with a mean (standard deviation) of 1.07 (2.71), and 78 space units had no deaths. One risk cluster of TB mortality was found in the south region (RR = 2.64, p = 0.01). Considering the social variables, several clusters were identified in the social risk indicator (SRI): income (899.82/1752.94; 0.024), GINI Index (0.41/0.45; 0.010), and overcrowding (25.07/15.39; 0.032). The SRI showed a high capacity to discriminate the TB mortality areas (area under ROC curve 0.865, 95% CI: 0.796-0.934). Conclusions: A powerful risk map (SRI) was developed, allowing tailored and personalised interventions. The south of Curitiba was identified as a high-risk area for TB mortality and the majority of social variables. This methodological approach can be generalised to other areas and/or other public health problems. (C) 2020 The Author( s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. (AU)

• Processo FAPESP: 15/17586-3 - A mortalidade por tuberculose e sua relação com as iniquidades sociais: um estudo multicêntrico
• Beneficiário: Ricardo Alexandre Arcêncio
• Modalidade de apoio: Auxílio à Pesquisa - Regular