Brazilian cities profile, the occurence of tuberculosis and its drug-resistant form

Jacobs, Marina Gasino; Pinto, Vitor Laerte

doi:10.1590/1413-81232018247.20532017

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HIGHLIGHT • Ciênc. saúde colet. 24 (7) • July 2019 • https://doi.org/10.1590/1413-81232018247.20532017 copy

Brazilian cities profile, the occurence of tuberculosis and its drug-resistant form

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Tuberculosis is closely related to living conditions. This study classifies Brazilian municipalities according to the occurrence of tuberculosis (TB) and drug-resistant TB (DR-TB) cases and describes them with regard to the population’s health conditions, tuberculosis control indicators, demographic and socioeconomic profile. In 2014, 327 municipalities reported DR-TB cases. Integrated regions of development or metropolitan regions accounted for 80.1% of national DR-TB cases. Municipalities with DR-TB cases had worse TB outcome indicators, but higher culture test percentages, and more inhabitants and better socioeconomic indicators. The 3,644 municipalities with TB cases, but without DR-TB cases, had the worst socioeconomic indicators among the three groups. The 1,594 municipalities without TB cases had the lowest rates of unemployment and AIDS detection and greater coverage of primary healthcare. The different profiles found in the study can sustain improved national interventions for TB and drug-resistant TB control in Brazil.

Drug-resistant tuberculosis; Socioeconomic factors; Cities; Health equity; Public health

Variables	Median (Q1-Q3*)		p

	Municipalities with DR-TB cases	Municipalities without DR-TB cases, with TB cases
TB incidence rate (/100,000)	34.17	19.71	0.00
TB incidence rate (/100,000)	(22.3 – 53.5)	(11.9 – 31)	0.00
Culture test among new cases (%)	20.29	0	0.00
Culture test among new cases (%)	(7.1 – 50.3)	(0 – 33.3)	0.00
Laboratory-confirmed pulmonary cases (%)	91.82	100	0.00
Laboratory-confirmed pulmonary cases (%)	(85.7 – 98.4)	(80.3 - 100)	0.00
HIV testing in new TB cases (%)	85.71	80	0.62
HIV testing in new TB cases (%)	(66.7 – 95.7)	(46.7 - 100)	0.62
TB-HIV coinfection among new cases (%)	7.14	0	0.00
TB-HIV coinfection among new cases (%)	(2.4 – 12.5)	(0 – 3.8)	0.00
Cure among new TB cases (%)	73.27	77.78	< 0.01
Cure among new TB cases (%)	(61.8 - 85)	(50 - 100)	< 0.01
Loss to follow-up among new TB cases (%)	6.53	0	0.00
Loss to follow-up among new TB cases (%)	(0 - 12)	(0 - 0)	0.00
Death among new TB cases (%)	0 (0-2,9)	1 (0-0)	0.00
Transference and unknown outcome among new TB cases (%)	6.01	0	0.00
Transference and unknown outcome among new TB cases (%)	(0 – 15.7)	(0 - 20)	0.00
Failure among new TB cases (%)	0	0	0.00
Failure among new TB cases (%)	(0 - 0)	(0 - 0)	0.00
Retreatment among total TB cases (%)	15.43	0	0.00
Retreatment among total TB cases (%)	(9.8 - 20)	(0 – 14.3)	0.00
Culture tests among retreated TB cases (%)	50	0	0.00
Culture tests among retreated TB cases (%)	(14.6 – 77.8)	(0 – 66.7)	0.00
Directly observed treatment (%)	49.05	60	0.00
Directly observed treatment (%)	(20 - 75)	(14.3 - 100)	0.00

Variables	Median (Q1-Q3*)			p

	Municipalities with DR-TB cases	Municipalities without DR-TB cases, with TB cases	Municipalities without TB cases
AIDS detection rate	6.99	0	0	< 0.01
AIDS detection rate	(3.5 – 11.4)	(0 –6.2)	(0 – 0)	< 0.01
Infant mortality (per 1,000 live births)	12.2	14.2	19.96	< 0.01
Infant mortality (per 1,000 live births)	(9.7 – 14.8)	(9.9 – 20)	(13.2 – 29.4)	< 0.01
Life expectancy at birth (years)	74.82	73.11	73.81	< 0.01
Life expectancy at birth (years)	(73.2 – 76.1)	(70.8 – 75)	(71.7 – 75.2)	< 0.01
Population covered by basic healthcare (%)	77.64	100	100	< 0.01
Population covered by basic healthcare (%)	(59.3 – 98.3)	(87.3 - 100)	(100 - 100)	< 0.01
Population sharing room with two or more people (%)	27.16	24.98	17.61	< 0.01
Population sharing room with two or more people (%)	(19.7 – 35.1)	(17.2 – 34.3)	(11.6 – 26.8)	< 0.01
Per capita average household income (R$)	656.07	424.8	471.42	< 0.01
Per capita average household income (R$)	(442 – 861.7)	(262.9 – 623.8)	(289.5 – 623.8)	< 0.01
Number of inhabitants	112,032	15,379	4,850	< 0.01
Number of inhabitants	(30,830- 274,838)	(8,165- 28,791.5)	(3,202- 7,774)	< 0.01
Population living in extreme poverty (%)	2.15	8.44	5.39	< 0.01
Population living in extreme poverty (%)	(0.1 - 7)	(1.9 – 21.1)	(1.8 - 17)	< 0.01
Unemployment in the population aged 16 or over (%)	7.6	6.18	4.52	< 0.01
Unemployment in the population aged 16 or over (%)	(5.9 – 10.1)	(4.3- 8.4)	(2.5 – 6.8)	< 0.01
Illiteracy among the population aged 15 years and over	6.56	14.41	12.78	< 0.01
Illiteracy among the population aged 15 years and over	(4.1 – 12)	(8.4- 25.5)	(8.6- 22)	< 0.01
Per capita GDP (R$)	15,107.63	8,743.45	9,481.21	< 0,01
Per capita GDP (R$)	(9,506 – 25,396)	(4,898 – 14,580)	(5,592 – 14,915)	< 0,01
MHDI	0.73	0.66	0.67	< 0.01
MHDI	(0.7 – 0.8)	(0.6 – 0.7)	(0.6 – 0.7)	< 0.01
GINI index	0.52	0.51	0.48	< 0.01
GINI index	(0.5 – 0.6)	(0.5- 0.6)	(0.4 – 0.5)	< 0.01
Population density (people / km2)	164.91	26.01	17.32	< 0.01
Population density (people / km2)	(57 – 633.7)	(12.1- 57.2)	(8.4 – 29.1)	< 0.01
Urban population (%)	93.93	66.91	56.19	< 0.01
Urban population (%)	(79.9 – 98.6)	(48.7 – 83.1)	(40.3 – 72.2)	< 0.01

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

MG Jacobs and VL Pinto Júnior contributed significantly to the work, approved the content, and agreed to subsequent revisions as well as final revision of the manuscript.