Identifying socioeconomic, epidemiological and operational scenarios for tuberculosis control in Brazil: an ecological study.

Autor:	Pelissari DM; National Tuberculosis Program of Brazil, Ministry of Health, Brasília, Distrito Federal, Brazil., Rocha MS; National Tuberculosis Program of Brazil, Ministry of Health, Brasília, Distrito Federal, Brazil., Bartholomay P; National Tuberculosis Program of Brazil, Ministry of Health, Brasília, Distrito Federal, Brazil., Sanchez MN; Department of Public Health, University of Brasília, Brasília, Distrito Federal, Brazil.; Institute of Health Technology Assessment, Porto Alegre, Rio Grande do Sul, Brazil., Duarte EC; Medical School, University of Brasília, Brasília, Distrito Federal, Brazil., Arakaki-Sanchez D; National Tuberculosis Program of Brazil, Ministry of Health, Brasília, Distrito Federal, Brazil., Dantas CO; National Tuberculosis Program of Brazil, Ministry of Health, Brasília, Distrito Federal, Brazil., Jacobs MG; National Tuberculosis Program of Brazil, Ministry of Health, Brasília, Distrito Federal, Brazil., Andrade KB; National Tuberculosis Program of Brazil, Ministry of Health, Brasília, Distrito Federal, Brazil., Codenotti SB; National Tuberculosis Program of Brazil, Ministry of Health, Brasília, Distrito Federal, Brazil., Andrade ESN; National Tuberculosis Program of Brazil, Ministry of Health, Brasília, Distrito Federal, Brazil., Araújo WN; Institute of Health Technology Assessment, Porto Alegre, Rio Grande do Sul, Brazil.; Faculty of Ceilandia, University of Brasília, Brasília, Distrito Federal, Brazil., Costa FD; National Tuberculosis Program of Brazil, Ministry of Health, Brasília, Distrito Federal, Brazil., Ramalho WM; Faculty of Ceilandia, University of Brasília, Brasília, Distrito Federal, Brazil., Diaz-Quijano FA; Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2018 Jun 06; Vol. 8 (6), pp. e018545. Date of Electronic Publication: 2018 Jun 06.
DOI:	10.1136/bmjopen-2017-018545
Abstrakt:	Objectives: To identify scenarios based on socioeconomic, epidemiological and operational healthcare factors associated with tuberculosis incidence in Brazil. Design: Ecological study. Settings: The study was based on new patients with tuberculosis and epidemiological/operational variables of the disease from the Brazilian National Information System for Notifiable Diseases and the Mortality Information System. We also analysed socioeconomic and demographic variables. Participants: The units of analysis were the Brazilian municipalities, which in 2015 numbered 5570 but 5 were excluded due to the absence of socioeconomic information. Primary Outcome: Tuberculosis incidence rate in 2015. Data Analysis: We evaluated as independent variables the socioeconomic (2010), epidemiological and operational healthcare indicators of tuberculosis (2014 or 2015) using negative binomial regression. Municipalities were clustered by the k-means method considering the variables identified in multiple regression models. Results: We identified two clusters according to socioeconomic variables associated with the tuberculosis incidence rate (unemployment rate and household crowding): a higher socioeconomic scenario (n=3482 municipalities) with a mean tuberculosis incidence rate of 16.3/100 000 population and a lower socioeconomic scenario (2083 municipalities) with a mean tuberculosis incidence rate of 22.1/100 000 population. In a second stage of clusterisation, we defined four subgroups in each of the socioeconomic scenarios using epidemiological and operational variables such as tuberculosis mortality rate, AIDS case detection rate and proportion of vulnerable population among patients with tuberculosis. Some of the subscenarios identified were characterised by fragility in their information systems, while others were characterised by the concentration of tuberculosis cases in key populations. Conclusion: Clustering municipalities in scenarios allowed us to classify them according to the socioeconomic, epidemiological and operational variables associated with tuberculosis risk. This classification can support targeted evidence-based decisions such as monitoring data quality for improving the information system or establishing integrative social protective policies for key populations. Competing Interests: Competing interests: None declared. (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
Databáze:	MEDLINE
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