摘要
Background:In Brazil,people still fall ill and die from tuberculosis(TB),and this can be explained by the significant impasse in the equity of distribution of therapeutic resources to the population as a whole.The aim was to identify geographical areas which have shown progress in terms of equity(of income,schooling and urban occupancy)and test its effect on mortality from TB in a municipality of southeast Brazil.Methods:It is an ecological study considering TB as the basic cause for deaths registered between 2006 and 2013 on the Mortality Information System and other variables obtained through the Demographic Census of the Brazilian Institute of Geography and Statistics(2010).The geographical area for analysis comprised the areas of coverage of the health services.Social indicators have been constructed through the Principal Component Analysis(PCA).The cases were geocoded and the annual mortality rate from TB was calculated with smoothing using the local empirical Bayesian method.Multiple linear regression was then performed.There was confirmation of the existence of spatial dependence of residue through the application of the Global Moran I test,and application of the Models with Global Spatial Effects,to identify the best standard of spatial regression.Results:The mortality rates ranged from 0.00 to 2.8 deaths per 100,000 people,per year.In the PCA,three indicators were constructed,and designated as indicators of income,social inequality,and social equity.In multiple linear regression,the indicator of social equity was statistically significant(P<0.0001)but had a negative association,an adjusted R^(2)of 28.36%and with spatial dependence(Moran I=0.21,P=0.003455).The best model to deal with existing spatial dependence was the Spatial Lag Model.Conclusions:The better social conditions have shown progress in reducing mortality from TB,thereby reinforcing the achievement of Sustainable Development Goals.In addition,cartography was also applied,which can be replicated in other scenarios throughout the world,using a scope distinct from that of works traditionally produced in that it places the emphasis on social equity.
基金
The authors received financial support from the National Scientific and Technological Development Council,Sao Paulo Research Foundation and Coordination of Improvement of Higher Level Personnel for the implementation the study
MY received financial assistance from Sao Paulo Research Foundation(Process number:2011/22834-5)
Coordination of Improvement of Higher Level Personnel(Programa Nacional de Pós Doutorado/Capes-PNPD)
RAA received financial assistance from the National Council for Scientific and Technological Development as a researcher(Process number:305,236/2015-6)
from the Sao Paulo Research Foundation(Process:2015/17586-3)
The funders had no role in any part of the study design,data collection or analysis,in the decision to to implement the smoothing process provided by the use of the local empirical Bayesian model,which smooths the gross rates by applying weighted averages,resulting in a corrected and more stable rate,considering not only the information of the area,but also those of its neighborhood’.At this stage,we used the Terraview 4.2.2 and ArcGis 10.2 software packages for the preparation of the chropleth maps.Publish,or in the preparation of the manuscript.Website:http://cnpq.br/(National Council for Scientific and Technological Development)http://www.fapesp.br/en/(Sao Paulo Research Foundation)http://www.capes.gov.br/(Coordination of Improvement of Higher Level Personnel)。
