Abstract
Tuberculosis remains a major health problem worldwide, killing thousand adults and children every year mainly in developing countries as Brazil. The disease is socially determined, caused mainly by inequalities as overcrowding, bad conditions of housing, unemployment, and limited access to health care. The aim of this study was to identify the social inequalities associated with the onset of tuberculosis in disease-prone territories in a city from the Northeast. This was an ecological study, which has gathered patients diagnosed with tuberculosis through secondary data source in a city from the northeast of Brazil. The GAMLSS statistical model has been applied considering as response variable the count of Tuberculosis cases and the independent variable, the social conditions. The double Poisson distribution was considered in the analysis. The best model fitted was selected according the Akaike information criterion value. For all tests, the p value < 0.05 was considered as statistically significant. 460 patients with diagnosis of tuberculosis were identified, which represents an incidence of 36.3 cases/100,000 in males and 20.7 cases/100,000 in females. Regarding social inequality associated with tuberculosis, income (households with per capita income between 1/8 and 3 minimum wages), gender and age (Proportion of males under 15 years of age) were associated with the disease. The findings evidenced the social determinants associated with tuberculosis, with a greater occurrence of the disease in areas with mostly male children and low-income families, these issues must be managed within and beyond the health sector, which is mandatory for the Tuberculosis elimination.
Highlights
Tuberculosis remains a major health problem worldwide, killing thousand adults and children every year mainly in developing countries as Brazil
It should be emphasized that the proportion of people in extreme poverty is increasing in Latin America, with 62 million living in extreme poverty (10.2% of the population), according to data from the Pan American Health Organization (PAHO), report of 2018, which leads to worsening health indicators and persistence of the disease in this scenario [4]
It is understood that studying the inequalities of TB means identifying the value of this dimension for the people that live in situations of vulnerability, with an absence of or weakness in strategic policies or actions related to the social determinants, where it is likely that this scenario will remain unchanged [16]
Summary
Tuberculosis remains a major health problem worldwide, killing thousand adults and children every year mainly in developing countries as Brazil. The aim of this study was to identify the social inequalities associated with the onset of tuberculosis in disease-prone territories in a city from the Northeast. In the Region of the Americas, TB represents the second greatest cause of death from a single infectious agent [3], with Brazil being one of the main countries responsible for the dimension of the disease on this continent. It is currently the most lethal infectious disease, and its persistence is due in large part to the serious inequalities and inequities present in the Americas [4]. Overcoming TB implies an accurate view of living conditions, the modes of production and social reproduction in the territories, as well as the social determinants
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