Nursing College of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
State University of West Paraná, Avenida Paraná, 1610, Foz do Iguaçu, Paraná, 85863-720, Brazil.
BMC Public Health. 2018 Jun 26;18(1):795. doi: 10.1186/s12889-018-5623-2.
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.
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.
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).
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.
世界卫生组织（WHO）发起了“终结结核病策略”，目标是到 2035 年将结核病（TB）死亡率降低 95%。巴西对此做出了承诺，但面临的一个挑战是在边境地区实现这一目标，因为该地区的结核病情况更为严峻。因此，本研究旨在分析巴西、巴拉圭和阿根廷边境地区普通人群中结核病死亡的空间分布及其社会经济决定因素，并探讨该地区的时间趋势。
本生态研究考虑了福斯杜伊瓜苏（巴西）居民的结核病死亡病例，其分析单位是普查区。计算了每个地区的标准化死亡率。社会经济变量数据来自巴西地理与统计研究所（IBGE）的 2010 年人口普查。应用扫描统计计算了空间相对风险（RR），置信区间为 95%。应用全局二元 Moran I 和局部二元 Moran I（LISA）分析空间相关性，以检验城市地区社会经济条件与结核病死亡率之间的关系。还使用 Prais-Winsten 检验分析了时间趋势。
共发现 74 例结核病死亡病例，其中 53 例（71.6%）为男性，51 例（68.9%）为白种人。死亡率范围为 0.28 至 22.75 例/10 万居民。发现一个空间相对风险区域，RR=5.07（95%CI 1.79-14.30）。死亡率与以下因素相关：棕色皮肤人群比例（I：0.0440，p=0.033）、收入（低收入 I：-0.0611，p=0.002；高收入 I：-0.0449，p=0.026）和居民密度（3 人和 4 人，I：0.0537，p=0.007；10 人或更多人，I：-0.0390，p=0.035）。棕色皮肤人群的死亡率有所增加（6.1%；95%CI=0.029，0.093）。
结核病死亡与收入、居民种族密度和社会条件有关。尽管普通人群的结核病死亡率保持稳定，但棕色皮肤人群的死亡率正在上升。
