Effect of social development in reducing tuberculosis mortality In northeastern Brazil areas.

Ana Angélica Rêgo Queiroz,Maria Concebida Da Cunha Garcia,Ricardo Alexandre Arcêncio,Mellina Yamamura,Marcos Augusto Moraes Arcoverde,Thaís Zamboni Berra,Alexandre Tadashi Inomata Bruce,Danielle Talita Dos Santos,Luana Seles Alves,Francisco Chiaravalloti-Neto,Tereza Cristina Scatena Villa,Pedro Fredemir Palha

doi:10.3855/jidc.12196

Abstract

Tuberculosis (TB) is the primary cause of death among infectious diseases affecting groups in extreme poverty. Social improvements could reverse this situation in Brazil. This study aims to demonstrate the spatial relationship between social development (SD) and TB mortality in Natal, a city in northeastern Brazil. Ecological study. The study population comprised TB deaths recorded in the Mortality Information System between 2008 and 2014. The units of analysis were 59 human development units (HDUs). Raw and smoothed mortality rates were calculated using the global empirical Bayes method. Primary components analysis was used to develop the SD indicators. An association between TB mortality and SD was verified using multiple linear regression analysis. Spatial autocorrelation was verified using models with global spatial effects. Analyses were performed using Statistica version 12.0, ArcGIS version 10.2, Statistical Package for the Social Sciences version 20.0, and OpenGeoDa 1.0.1. The significance level was established at 5% (p < 0.05). The TB mortality rate with non-random spatial distribution ranged between 0.52 and 8.90 per 100,000 inhabitants. The spatial lag model was chosen because it presented the highest log-likelihood value, lowest AIC, and highest R2. A negative association was found between TB mortality and SD (R2 = 0.207; p = 0.03). The results show a negative association between TB mortality and the high SD indicator. This study can support decision-making in terms of collective projects within public health in order to link the health field to other sectors, aiming for social well-being and human development.

Highlights

Tuberculosis (TB) is the primary cause of death among infectious diseases affecting groups in extreme poverty
The human development units (HDUs) located in the north and south of the city presented the lowest rates
The results showed a pattern of non-random distribution of TB mortality, which was confirmed by geospatial intelligence techniques, such as the Moran Index

Summary

Introduction

Tuberculosis (TB) is the primary cause of death among infectious diseases affecting groups in extreme poverty. This study aims to demonstrate the spatial relationship between social development (SD) and TB mortality in Natal, a city in northeastern Brazil. Conclusions: The results show a negative association between TB mortality and the high SD indicator. This study can support decision-making in terms of collective projects within public health in order to link the health field to other sectors, aiming for social well-being and human development. Tuberculosis (TB) is one of the primary causes of death from infectious disease in the world [1], mainly due to HIV co-infection, unequal social development (SD), and limited access to health services. Studies [7,8] stress that populations living under these conditions face difficult access to quality health services, which results in delayed diagnosis, nonadherence to treatment, and, in the worst scenario, death.

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