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. 2019 May 8;19(1):87.
doi: 10.1186/s12890-019-0855-1.

Social Determinants of Pulmonary Tuberculosis in Brazil: An Ecological Study

Free PMC article

Social Determinants of Pulmonary Tuberculosis in Brazil: An Ecological Study

Alessandra Isabel Zille et al. BMC Pulm Med. .
Free PMC article


Background: Social determinants may influence the incidence and control of tuberculosis (TB). The aim of this study was to evaluate the correlation between social determinants and pulmonary TB (PTB) incidence and treatment outcomes in different regions in Brazil.

Methods: In this ecological study, PTB incidence and treatment outcome rates as well as HIV incidence for all 5560 Brazilian cities as reported to the Brazilian Tuberculosis Program in 2010 were correlated with two social indicators, the Human Development Index (HDI) and Gini Index (GI). Cities were stratified into six groups based on location (metropolitan region or not) and size (small, medium, and large cities), and according to the regions of the country to which they belong. The Spearman correlation coefficient was used to assess the association between variables.

Results: In 2010, 68,729 new PTB cases were reported in Brazil, with an incidence rate of 36 cases per 100,000 inhabitants. Incidence rates and PTB mortality demonstrated a weak negative correlation with HDI and a positive correlation with GI. The correlation between HDI and GI with cure, relapse, and lost to follow-up of treatment greatly varied in the different groups of cities and regions of the country evaluated.

Conclusions: There is a weak correlation between HDI and GI and PTB incidence and mortality rate. However, there is great variation between the HDI and GI and cure, relapse, and lost to follow-up in the different groups of cities and regions of the country. This suggests that for TB determination, these outcome variables might be more related to the quality of healthcare provided by services than to social determinants in the general population.

Keywords: Income; Inequality; Social indicators; Tuberculosis.

Conflict of interest statement

Ethics approval and consent to participate

The study was submitted to the Research Ethics Committee of the Federal University of Rio de Janeiro - Clementino Fraga Filho University Hospital (May 2013), which exempted the need for ethical approval because it is ecological research based on public secondary data.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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