Impact of the improvement of living conditions on tuberculosis mortality in Brazil: an ecological study.

IF 1.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL Sao Paulo Medical Journal Pub Date : 2024-08-26 eCollection Date: 2024-01-01 DOI:10.1590/1516-3180.2023.0279.R1.13052024

Marcio Natividade, Marcos Pereira, Christine Stauber, Samilly Miranda, Maria Glória Teixeira, Ramon Andrade de Souza, Marilia Santos Dos Anjos, Rafael Barros, Daniela Gonçalves Morato, Erika Aragão, Susan Martins Pereira, Maria da Conceição Nascimento Costa

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Abstract

Background: The risk of death due to tuberculosis (TB) in Brazil is high and strongly related to living conditions (LC). However, epidemiological studies investigating changes in LC and their impact on TB are lacking.

Objectives: To evaluate the impact of LC on TB mortality in Brazil.

Design and setting: This ecological study, using panel data on spatial and temporal aggregates, was conducted in 1,614 municipalities between 2002 and 2015.

Methods: Data were collected from the Mortality Information System and the Brazilian Institute of Geography and Statistics. The proxy variable used for LC was the Urban Health Index (UHI). Negative binomial regression models were used to estimate the effect of the UHI on TB mortality rate. Attributable risk (AR) was used as an impact measure.

Results: From 2002 to 2015, TB mortality rate decreased by 23.5%, and LC improved. The continuous model analysis resulted in an RR = 0.89 (95%CI = 0.82-0.96), so the AR was -12.3%. The categorized model showed an effect of 0.92 (95%CI = 0.83-0.95) in municipalities with intermediate LC and of 0.83 (95%CI = 0.82-0.91) in those with low LC, representing an AR for TB mortality of -8.7% and -20.5%, respectively.

Conclusions: Improved LC impacted TB mortality, even when adjusted for other determinants. This impact was greater in the strata of low-LC municipalities.

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改善生活条件对巴西结核病死亡率的影响：一项生态研究。

背景：在巴西，肺结核（TB）导致死亡的风险很高，并且与生活条件（LC）密切相关。然而，巴西缺乏对生活条件变化及其对结核病影响的流行病学研究：评估生活条件对巴西肺结核死亡率的影响：这项生态研究使用了空间和时间总量的面板数据，于 2002 年至 2015 年间在 1614 个城市进行：数据收集自死亡率信息系统和巴西地理统计研究所。LC 使用的替代变量是城市健康指数（UHI）。负二项回归模型用于估计 UHI 对肺结核死亡率的影响。采用可归因风险（AR）作为影响度量：从 2002 年到 2015 年，结核病死亡率下降了 23.5%，LC 也有所改善。连续模型分析得出 RR = 0.89（95%CI = 0.82-0.96），因此 AR 为-12.3%。分类模型显示，中等低密度脂蛋白血症城市的影响为 0.92（95%CI = 0.83-0.95），低密度脂蛋白血症城市的影响为 0.83（95%CI = 0.82-0.91），结核病死亡率的 AR 分别为-8.7% 和-20.5%：结论：即使对其他决定因素进行调整，低营养水平的改善也会影响结核病死亡率。这种影响在低LC城市的阶层中更大。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Sao Paulo Medical Journal 医学-医学：内科

CiteScore

2.20

自引率

7.10%

发文量

210

审稿时长

6-12 weeks

期刊介绍： Published bimonthly by the Associação Paulista de Medicina, the journal accepts articles in the fields of clinical health science (internal medicine, gynecology and obstetrics, mental health, surgery, pediatrics and public health). Articles will be accepted in the form of original articles (clinical trials, cohort, case-control, prevalence, incidence, accuracy and cost-effectiveness studies and systematic reviews with or without meta-analysis), narrative reviews of the literature, case reports, short communications and letters to the editor. Papers with a commercial objective will not be accepted.