Tuberculosis incidence inequalities and its social determinants in Manaus from 2007 to 2016
Tuberculosis incidence inequalities and its social determinants in Manaus from 2007 to 2016
Data
2018
Autores
Castro, Daniel Barros de
Maciel, Elvira Maria Godinho de Seixas
Sadahiro, Megumi
Pinto, Rosemary Costa
Albuquerque, Bernardino Cláudio de
Braga, José Ueleres
Journal Title
Journal ISSN
Volume Title
Publisher
International Journal for Equity in Health
Resumo
Background: Brazil is among the 30 countries with high-burden of tuberculosis worldwide, and Manaus is the
capital with the highest tuberculosis incidence. The accelerated economic and population growth in Manaus in the
last 30 years has strengthened the process of social stratification that may result in population groups that are less
favored in terms of healthcare and are vulnerable to infection and illness due to tuberculosis. This study aimed to
characterize inequalities associated with tuberculosis incidence in relation to the socioeconomic and demographic
characteristics of the resident population of Manaus and to identify their determinants from 2007 to 2016.
Methods: An ecological study was conducted using the data from the Diseases Notification Information System.
Tuberculosis incidence rates by population characteristics (gender, ethnicity, and socioeconomic level) were
calculated for each year, studied, and represented in equiplot charts. To measure the disparity of tuberculosis
incidence in the resident population in Manaus, the Gini index of tuberculosis in each neighborhood was
calculated based on the incidence rates of the census sectors. A thematic map was constructed to represent the
spatial distribution of tuberculosis incidence inequality. Linear regression models were used to identify the
relationship between the tuberculosis incidence inequality and its social determinants.
Results: From 2007 to 2016, there was an increase in the tuberculosis incidence in Manaus, together with an
increase in incident inequality among genders, ethnic groups, and socioeconomic level. The incidence of
tuberculosis inequality was associated with the inequalities of its possible determinants (Gini of the proportion of
male population, Gini of the proportion of indigenous population, Gini of the proportion of illiteracy, Gini of
income, Gini of the proportion of households connected to the water network, and Gini of the mean number of
bathrooms per inhabitant), the per capita income, and the proportion of cases with laboratory confirmation.
Conclusions: Disparities in tuberculosis incidence in the resident population in neighborhoods can be explained by
the sociodemographic and economic heterogeneity. Our findings recommend that public policies and tuberculosis
control strategies consider differences in the determinants of tuberculosis inequality for the development of specific
actions for each population group.
Description
Palavras-chave
Healthcare disparities, Socioeconomic level, Tuberculosis, Brazil
Citação
Castro, D.B., de Seixas Maciel, E.M.G., Sadahiro, M. et al. Tuberculosis incidence inequalities and its social determinants in Manaus from 2007 to 2016. Int J Equity Health 17, 187 (2018). https://doi.org/10.1186/s12939-018-0900-3