Spatial Distribution of Tuberculosis and Socioeconomic Inequalities in Cochabamba, Bolivia

Abstract

Background: Through their associations with the incidence of tuberculosis, socioeconomic variables contribute to the burden and the spread of the disease, especially in developing countries. Because there is no such data in Bolivia, we conducted an ecological study to evaluate the spatial distribution of tuberculosis and its relationship with socioeconomic determinants in the Department of Cochabamba. Methods: Incidence of tuberculosis was computed from the 2016 data reported from the Tuberculosis Control Program and the socioeconomic indicators were retrieved from the Bolivian Population and Housing Census of the National Institute of Statistics conduced in 2012 at the municipality level. Incidence rates were standardized by age and were mapped to visualize the spatial distribution. Pearson correlation coefficients were used for associations. Results: The spatial distribution of tuberculosis showed a high incidence in the Tropical Region with 163 cases/100,000. The Metropolitan Region showed a lower incidence of 52 cases/100,000 and the Valleys, Southern Cone and Andean Regions showed an ever lower incidence, with 26 cases/100,000. In the Tropical Region where there was a high incidence in all five municipalities, there was a negative correlation with school attendance (r=-0.46) and a positive correlation with population density (r=0.62). In the Metropolitan Region presented with medium incidences, a positive correlation with population density was observed (r=0.52) across de 8 municipalities. In the joint analysis of the 34 municipalities of the Regions Andean, Southern Cone and Valleys having the lowest incidences, a quite low correlation was observed with all socioeconomic variables. In all regions, a moderate to highly positive correlation was observed with the variable “not be owner of its housing”: Tropical Region (r=0.65), Metropolitan Region (r=0.82) and Valleys, Southern Cone and Andean Regions (r=0.51). Conclusions: The pattern of the distribution of the incidence of tuberculosis showed a high incidence in all areas of the Tropical Region. Each of the 3 regions had its own socioeconomic variables associated with tuberculosis incidence but the variable “not be owner of its housing” was however positively associated with TB incidence in all regions.