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. 2024 Aug 26;142(6):e2023279.
doi: 10.1590/1516-3180.2023.0279.R1.13052024. eCollection 2024.

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

Marcio Natividade  1 , Marcos Pereira  1 , Christine Stauber  2 , Samilly Miranda  1 , Maria Glória Teixeira  3 , Ramon Andrade de Souza  4 , Marilia Santos Dos Anjos  4 , Rafael Barros  5 , Daniela Gonçalves Morato  6 , Erika Aragão  7 , Susan Martins Pereira  7 , Maria da Conceição Nascimento Costa  7
Affiliations

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

Marcio Natividade et al. Sao Paulo Med J. .

Abstract

Background: The 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.

Objectives: To evaluate the impact of LC on TB mortality in Brazil.

Design and setting: This ecological study, using panel data on spatial and temporal aggregates, was conducted in 1,614 municipalities between 2002 and 2015.

Methods: Data 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.

Results: From 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.

Conclusions: Improved 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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Conflict of interest statement

Conflict of interest: None

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