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

Abstract

Objective To characterise tuberculosis deaths in a region of northeast Brazil during the period from 2006 to 2017 and to identify determinants associated with areas with higher tuberculosis mortality rates. Methods Ecological descriptive study of deaths from tuberculosis with multivariate mapping and logistic regression, carried out from 2006 to 2017 in the 75 municipalities of Sergipe, Brazil. The focus of the analysis was the mean mortality rate from tuberculosis, dichotomised according to the median. The independent variables were selected based on the conceptual model of the social determinants of health. Results Mortality due to tuberculosis in Sergipe, Brazil, was most prevalent among males, mixed‐race people, and people over 40 years old and with a low level of education. Multivariate logistic regression identified the mean incidence rate for tuberculosis (aOR: 1.06), the proportion of HIV testing (aOR: 7.10), people without primary education and with informal occupation (aOR: 1.26) and people living in urban households without waste collection service (aOR: 0.10) as determinants associated to municipalities with higher tuberculosis mortality rates, with area under the ROC curve of 84% (P‐value 0.000). Mapping revealed evident spatial variability. Conclusions The tuberculosis epidemic in Brazil is determined by access to health services, especially the provision of HIV testing among those diagnosed with tuberculosis, accelerated urbanisation with large pockets of poverty and unsanitary housing conditions, corroborating global trends.

Spatial analysis of tuberculosis cure in primary care in Rio de Janeiro, Brazil

“…The TB cure rate of 71.57% was lower than in other studies conducted in other regions of Brazil, such as 90.9% TB cure in the state of Maranhão [40]. However, it is higher than in other studies; Lima et al (2020) [41] found a median cure rate of 29.8% among cities in Northeast Brazil. Two other studies identified decreases Table 3 Final model of spatial analysis of TB cure for new TB cases and socioeconomic, demographic, and epidemiological variables using the generalized additive model -GAM (N = 14,384).…”

“…The Stop TB Strategy of the World Health Organization (WHO) recommends household contact investigations (HCI) for active screening of TB disease among contacts of smear-positive TB cases [1]. Saunders et al (2018) found higher risk of progression to TB disease among close contacts of pulmonary TB cases, but the diagnostic accuracy to predict each outcome is poor [41]. Another study concluded that proactive social policies and active contact tracing to identify missed cases may help reduce the TB burden in this setting [5].…”

“…It is important that governments take responsibility for ensuring universal health coverage as a key element in achieving global goals [5,41]. In one study, primary care coverage was inversely associated with TB mortality in children [9].…”