Public Health School of University of São Paulo, São Paulo, Brazil São Paulo Municipal Department of Health, São Paulo, Brazil.
Trop Med Int Health. 2012 Nov;17(11):1417-24. doi: 10.1111/j.1365-3156.2012.03074.x. Epub 2012 Aug 22.
To analyse the profile of tuberculosis (TB) among Bolivian immigrants, investigate the impact that this population has on the trends of TB and assess equity in access to TB treatment, in the city of São Paulo, Brazil.
Descriptive study of the epidemiological profile of TB in four city districts with large Bolivian populations, comparing cases among Brazilians and Bolivians, during the 1998-2008 period was carried out. We used logistic regression to adjust the treatment outcome for potential confounders.
We identified 2056 new TB cases: 65.7% in Brazilians, 32.1% in Bolivians and 2.2% among other nationalities. Although TB incidence remained stable (high) over the study period, the annual proportion of cases among Bolivians increased from 15.0% to 53.0%. In comparison with the Brazilians, the Bolivians were younger (median age, 24 vs. 40 years; P < 0.0001) and presented a lower unemployment rate (3.1%vs. 11.6%; P < 0.0001), a lower rate of HIV co-infection (1.5%vs. 28.5%; P< 0.001), a higher proportion of individuals receiving supervised treatment (81.5%vs. 62.0%; P < 0.0001) and a higher proportion of cures (71.6%vs. 63.2%; P< 0.0001). After having been adjusted for potential confounder, cure after treatment was not associated with nationality.
Bolivian immigrants influenced the incidence but not the trends of TB among Brazilians in the study area. We found no significant differences between Bolivians and Brazilians regarding healthcare access or treatment outcome. Guaranteed universal health care access for all, including undocumented individuals, contributes to health equity. Specific intervention strategies are warranted for immigrants with tuberculosis.
分析玻利维亚移民中的结核病（TB）发病情况，研究该人群对巴西圣保罗市结核病发病趋势的影响，并评估结核病治疗机会均等情况。
对四个拥有大量玻利维亚移民人口的城市区域进行结核病流行特征的描述性研究，对 1998-2008 年间巴西人和玻利维亚人结核病发病情况进行比较。采用逻辑回归对潜在混杂因素进行调整，评估治疗效果。
共发现 2056 例新结核病病例：65.7%为巴西人，32.1%为玻利维亚人，2.2%为其他国籍。尽管研究期间结核病发病率保持稳定（较高），但玻利维亚人每年病例比例从 15.0%上升至 53.0%。与巴西人相比，玻利维亚人更年轻（中位数年龄 24 岁 vs. 40 岁；P<0.0001），失业率更低（3.1%vs. 11.6%；P<0.0001），HIV 合并感染率更低（1.5%vs. 28.5%；P<0.001），接受监督治疗的比例更高（81.5%vs. 62.0%；P<0.0001），治愈率更高（71.6%vs. 63.2%；P<0.0001）。调整潜在混杂因素后，治疗后的治愈率与国籍无关。
玻利维亚移民影响了研究地区巴西人中结核病的发病率，但未影响其发病趋势。我们发现，玻利维亚人和巴西人在获得医疗保健和治疗效果方面没有显著差异。全民享有有保障的卫生保健，包括无证件移民，有助于实现卫生公平。针对结核病移民，需要采取特定的干预策略。
