Abstract
OBJECTIVE To analyze the spatial distribution of risk for tuberculosis and its socioeconomic determinants in the city of Rio de Janeiro, Brazil.METHODS An ecological study on the association between the mean incidence rate of tuberculosis from 2004 to 2006 and socioeconomic indicators of the Censo Demográfico (Demographic Census) of 2000. The unit of analysis was the home district registered in the Sistema de Informação de Agravos de Notificação (Notifiable Diseases Information System) of Rio de Janeiro, Southeastern Brazil. The rates were standardized by sex and age group, and smoothed by the empirical Bayes method. Spatial autocorrelation was evaluated by Moran’s I. Multiple linear regression models were studied and the appropriateness of incorporating the spatial component in modeling was evaluated.RESULTS We observed a higher risk of the disease in some neighborhoods of the port and north regions, as well as a high incidence in the slums of Rocinha and Vidigal, in the south region, and Cidade de Deus, in the west. The final model identified a positive association for the variables: percentage of permanent private households in which the head of the house earns three to five minimum wages; percentage of individual residents in the neighborhood; and percentage of people living in homes with more than two people per bedroom.CONCLUSIONS The spatial analysis identified areas of risk of tuberculosis incidence in the neighborhoods of the city of Rio de Janeiro and also found spatial dependence for the incidence of tuberculosis and some socioeconomic variables. However, the inclusion of the space component in the final model was not required during the modeling process.
Highlights
Tuberculosis is a neglected disease,[10] which is endemic in several countries and accounts for about 1.3 million deaths annually.a It is estimated that one third of the world population is infected with Mycobacterium tuberculosis and is, at risk of developing the disease
Brazil was among the 22 countries with the highest disease burden, totaling 40,152 cases reported with the presence of resistant acid-fast bacilli in the sputum, and an incidence rate of 46 cases/100,000 inhabitants.a Rio de Janeiro is the Brazilian state with the highest occurrence rate.c
The objective of this study was to analyze the spatial distribution of risk for tuberculosis and its socioeconomic determinants in the city of Rio de Janeiro. This is an ecological study conducted in the city of Rio de Janeiro, RJ, Southeastern Brazil, on the association between the mean tuberculosis incidence rate over three years (2004, 2005, and 2006), and socioeconomic indicators obtained from the Censo Demográfico (Demographic Census) of 2000
Summary
Tuberculosis is a neglected disease,[10] which is endemic in several countries and accounts for about 1.3 million deaths annually.a It is estimated that one third of the world population is infected with Mycobacterium tuberculosis and is, at risk of developing the disease. 95.0% of the cases occur in developing countries.b In 2012, the worldwide estimated incidence of tuberculosis was 122 cases/100,000 inhabitants, and about 12 million prevalent cases in the world. The use of spatial analysis in public health covers many different topics. In the 2000s, several studies have been published on the distribution and determinants of communicable and noncommunicable diseases, focusing on different approaches.[1,12,18]
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