Abstract
Although many studies have identified social conditions associated with tuberculosis, contextual and individual factors have rarely been analysed simultaneously. Consequently, we aimed to identify contextual and individual factors associated with tuberculosis incidence in general population in Brazil in 2010. We also assessed whether household crowding mediates the association between socioeconomic determinants and tuberculosis incidence. Individual data of tuberculosis cases were obtained from 5,565 municipalities in Brazil in 2010 (last year of national census), and merged with contextual variables. The associations were evaluated in a multilevel analysis using negative binomial regression. After adjusting for individual factors (age, sex and race) and geographic region, the following contextual factors were associated with tuberculosis incidence rate: AIDS incidence rate [incidence rate ratio (IRR), 1.21; 95% confidence interval (CI), 1.18–1.24], unemployment rate (IRR, 1.16; 95% CI, 1.13–1.19), Gini coefficient (IRR, 1.05; 95% CI, 1.02–1.08), proportion of inmates (IRR, 1.11; 95% CI, 1.09–1.14), mean per capita household income (IRR, 0.94; 95% CI, 0.91–0.97) and primary care coverage (IRR, 0.94; 95% CI, 0.92–0.96). Inclusion of household crowding in the multivariate model led to a loss of the associations of both Gini coefficient and mean per capita household income. In conclusion, our findings suggest that income inequality and poverty, as determinants of tuberculosis incidence, can be mediated by household crowding. Moreover, prison population can represent a potential social reservoir of tuberculosis in Brazil and should be addressed as a priority for disease control. Finally, the negative association between primary health coverage and tuberculosis incidence highlights the importance of this level of care as a strategy to control this disease.
Highlights
Tuberculosis control still poses a challenge to public health services worldwide
The tuberculosis incidence rate was higher in men than in women, except for people younger than 15 years old
There were municipalities with good income equality (e.g., São Josedo Hortência, 28.4%) in the South region and municipalities with extreme income inequality (e.g., São Gabriel da Cachoeira, 80.8%) in the North region. This pattern of high variability was observed for other variables such as human development index, mean per capita household income and gross domestic product (GDP) per capita (Table 1)
Summary
Tuberculosis control still poses a challenge to public health services worldwide. In 2015, there were an estimated 10.4 million cases, primarily in Asia (61%) and Africa (26%). Household crowding and tuberculosis incidence in Brazil penitenciarias]. The individual datasets from tuberculosis and aids cases in Brazil analyzed during the current study are available by request in the “Sistema Eletronico do Servico de Informacão ao Cidadão” repository, [http://esic.cgu.gov.br/ sistema/site/index.html?ReturnUrl=%2fsistema]
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