Temporal trends in areas at risk for concomitant tuberculosis in a hyperendemic municipality in the Amazon region of Brazil

Background Although preventable and curable,tuberculosis(TB)still occurs in poor or developing countries,mainly in metropolitan regions of larger cities.The disease is a serious public health problem,and is directly linked to social issues.We analyzed temporal trend variations in areas at risk for concomitant TB,and characterized the clinical and epidemiological profiles of cases in a hyperendemic municipality in the Amazon region of Brazil.Methods This ecological study was performed in the municipality of Manaus,in northern Brazil.The population comprised cases with concomitant pulmonary and extrapulmonary TB,registered on the Notifiable Diseases Information System(SINAN),between January 1,2009 and December 31,2018.For risk cluster detection,spatial and spatiotemporal scanning statistical techniques were used.The Spatial Variation in Temporal Trends(SVTT)approach was used to detect and infer clusters for significantly different time trends.Results Between 2009 and 2018,873 concomitant TB cases were registered in Manaus.By using purely spatial scanning statistics,we identified two risk clusters.The relative risk(RR)of the clusters was 2.21(95%confidence interval[CI]:1.57–2.88;P=0.0031)and 2.03(95%CI:1.58–2.58;P=0.0029).Using space-time scanning,we identified a risk cluster with an RR of 3.57(95%CI:2.84–4.41;P=0.014),between 2017 and 2018.For SVTT analyses,three clusters with spatial variations were detected in the significant temporal trends:SVTT 1(P=0.042),SVTT 2(P=0.046)and SVTT 3(P=0.036).Conclusions In Brazil,several TB-determining factors such as race/color,gender,low educational level and low income overlap in needy urban areas and communities,demonstrating that it is unlikely to reach the goals,agreed and launched with the END TB Strategy within the deadlines of international agreements,if there is no reduction in existing inequities determinants and risk of illness in the country.

Areas with evidence of equity and their progress on mortality from tuberculosis in an endemic municipality of southeast Brazil

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.