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. 2018 Jun 26;18(1):795.
doi: 10.1186/s12889-018-5623-2.

How do social-economic differences in urban areas affect tuberculosis mortality in a city in the tri-border region of Brazil, Paraguay and Argentina

Marcos Augusto Moraes Arcoverde  1   2 , Thais Zamboni Berra  3 , Luana Seles Alves  3 , Danielle Talita Dos Santos  3 , Aylana de Sousa Belchior  3 , Antônio Carlos Vieira Ramos  3 , Luiz Henrique Arroyo  3 , Ivaneliza Simionato de Assis  3 , Josilene Dália Alves  3 , Ana Angélica Rêgo de Queiroz  3 , Mellina Yamamura  3 , Pedro Fredemir Palha  3 , Francisco Chiaravalloti Neto  4 , Reinaldo Antonio Silva-Sobrinho  5 , Oscar Kenji Nihei  5 , Ricardo Alexandre Arcêncio  3
Affiliations

How do social-economic differences in urban areas affect tuberculosis mortality in a city in the tri-border region of Brazil, Paraguay and Argentina

Marcos Augusto Moraes Arcoverde et al. BMC Public Health. .

Abstract

Background: The World Health Organization (WHO) launched the "End TB Strategy", which aims to reduce tuberculosis (TB) mortality by 95% by 2035, Brazil has made a commitment to this, however, one challenge is achieving the goal in the border region, where the TB situation is more critical. The proposal was to analyse the spatial mortality due to TB and its socio-economic determinants in the general population, around the border areas of Brazil, Paraguay and Argentina, as well as the temporal trend in this region.

Method: This ecological study considered the cases of TB deaths of residents of Foz do Iguaçu (BR), with its units of analysis being the census sectors. The standardized mortality rate was calculated for each area. Socioeconomic variables data were obtained from the 2010 Demographic Census of the Brazilian Institute of Geography and Statistics (IBGE). The scan statistic was applied to calculate the spatial relative risk (RR), considering a 95% confidence interval (CI). Spatial dependence was analysed using the Global Bivariate Moran I and Local Bivariate Moran I (LISA) to test the relationship between the socioeconomic conditions of the urban areas and mortality from TB. Analysis of the temporal trend was also performed using the Prais-Winsten test.

Results: A total of 74 cases of TB death were identified, of which 53 (71.6%) were male and 51 (68.9%) people of white skin colour. The mortality rate ranged from 0.28 to 22.75 cases per 100,000 inhabitants. A spatial relative risk area was identified, RR = 5.07 (95% CI 1.79-14.30). Mortality was associated with: proportion of people of brown skin colour (I: 0.0440, p = 0.033), income (low income I: - 0.0611, p = 0.002; high income I: - 0.0449, p = 0.026) and density of residents (3 and 4 residents, I: 0.0537, p = 0.007; 10 or more residents, I: - 0.0390, p = 0.035). There was an increase in the mortality rate in people of brown skin colour (6.1%; 95% CI = 0.029, 0.093).

Conclusion: Death due to TB was associated with income, race resident density and social conditions. Although the TB mortality rate is stationary in the general population, it is increasing among people of brown skin colour.

Keywords: Border crossing; Continental population group; Income; Races; Social inequity; Tuberculosis.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Human Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing, CAAE 54499116.8.0000.5393, authorization No. 1.482.499. The Committee accepted a statement with justification for the waiver of the consent term due to the fact that the research was carried out with secondary data from the SIM and the IBGE. The Brazilian legislation regarding Resolution 466/2012 was respected.

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.

Figures

Fig. 1
Fig. 1
Map of the scenario. Legend: (a) Brazil; (b) Border region with Paraguay and Argentina; (c) Detail Municipality of Foz do Iguaçu
Fig. 2
Fig. 2
Standardized mortality rate for tuberculosis, Foz do Iguaçu (BR), 2004–2015
Fig. 3
Fig. 3
Health district and area with RR for tuberculosis mortality, Foz do Iguaçu (BR), 2004–2015
Fig. 4
Fig. 4
Bivariate LISA Map of socioeconomic conditions and mortality rate from tuberculosis, Foz do Iguaçu, 2004–2015. Legend: a - Association with Proportion of residents with per capita income of up to 1/8 minimum wage; b - Association with Proportion of residents with per capita income of 10 or more minimum wages; c - Association with Proportion of residents of brown skin color; d - Association with Proportion of residents of Asian race; e - Association with Proportion of residents of white skin colour; f - Association with Proportion of households with 3 or 4 residents; g - Association with Proportion of households with 10 or more residents
Fig. 5
Fig. 5
Temporal trend of the tuberculosis mortality rate, Foz do Iguaçu (BR), 2004–2015. Legend: ARI = annual rate of increase (percentage); 95% CI = 95%confidence interval (percentage); Trend = interpretation of the trend
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