• Sao Paulo Med J · Jan 2024

    Impact of the improvement of living conditions on tuberculosis mortality in Brazil: an ecological study.

    • Marcio Natividade, Marcos Pereira, Christine Stauber, Samilly Miranda, Maria Glória Teixeira, SouzaRamon Andrade deRA0000-0003-1814-745XNurse, Postgraduate Program in Collective Health, Institute of Collective Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil., Marilia Santos Dos Anjos, Rafael Barros, Daniela Gonçalves Morato, Erika Aragão, Susan Martins Pereira, and CostaMaria da Conceição NascimentoMDCN0000-0001-7275-4280Associate Professor, Department of Public Health, Institute of Collective Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil..
    • Adjunct Professor, Department of Public Health, Institute of Collective Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
    • Sao Paulo Med J. 2024 Jan 1; 142 (6): e2023279e2023279.

    BackgroundThe risk of death due to tuberculosis (TB) in Brazil is high and strongly related to living conditions (LC). However, epidemiological studies investigating changes in LC and their impact on TB are lacking.ObjectivesTo evaluate the impact of LC on TB mortality in Brazil.Design And SettingThis ecological study, using panel data on spatial and temporal aggregates, was conducted in 1,614 municipalities between 2002 and 2015.MethodsData were collected from the Mortality Information System and the Brazilian Institute of Geography and Statistics. The proxy variable used for LC was the Urban Health Index (UHI). Negative binomial regression models were used to estimate the effect of the UHI on TB mortality rate. Attributable risk (AR) was used as an impact measure.ResultsFrom 2002 to 2015, TB mortality rate decreased by 23.5%, and LC improved. The continuous model analysis resulted in an RR = 0.89 (95%CI = 0.82-0.96), so the AR was -12.3%. The categorized model showed an effect of 0.92 (95%CI = 0.83-0.95) in municipalities with intermediate LC and of 0.83 (95%CI = 0.82-0.91) in those with low LC, representing an AR for TB mortality of -8.7% and -20.5%, respectively.ConclusionsImproved LC impacted TB mortality, even when adjusted for other determinants. This impact was greater in the strata of low-LC municipalities.

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