Institute of Biological and Health Sciences, Federal University of Mato Grosso, Barra do Garças, Brazil.
Epidemiology Department, Faculty of Public Health, University of São Paulo, São Paulo, Brazil.
Trans R Soc Trop Med Hyg. 2020 May 7;114(5):323-331. doi: 10.1093/trstmh/traa008.
Reducing TB mortality is a great challenge in Brazil due to its territorial extension, cultural variations and economic and political crises, which impact the health system. This study aimed to estimate in space and time the risk of TB mortality and test its relationship with social inequities.
This was an ecological study that included deaths from TB between 2006 and 2016 in Cuiabá, Brazilian Legal Amazon. Bayesian models based on the integrated nested Laplace approximation approach were used to estimate spatio-temporal RRs. RRs for TB mortality were obtained according to the covariables representative of social inequities.
The risk of TB mortality was stable between 2006 and 2016 and high-risk areas were identified throughout the municipality studied. Regarding social inequities, income was an important factor associated with TB mortality risk, as an increase of 1 SD in income resulted in a 35.4% (RR 0.646; CI 95% 0.476 to 0.837) decrease in risk.
The results provided evidence of areas with higher TB mortality risks that have persisted over time and are related to social inequities. Advancing social policies and protections in these areas will contribute to achieving the WHO's End TB strategy.
由于地域广阔、文化多样、经济和政治危机对卫生系统造成影响，巴西在降低结核病死亡率方面面临巨大挑战。本研究旨在对结核病死亡率的时空风险进行评估，并检验其与社会不平等之间的关系。
这是一项生态研究，纳入了巴西亚马孙法定地区首府库亚巴市 2006 年至 2016 年期间结核病死亡病例。采用基于集成嵌套拉普拉斯逼近方法的贝叶斯模型来估计时空相对风险。根据代表社会不平等的协变量，获得结核病死亡率的相对风险。
2006 年至 2016 年期间，结核病死亡率的风险保持稳定，在整个研究市均发现了高风险地区。就社会不平等而言，收入是与结核病死亡率风险相关的一个重要因素，收入每增加一个标准差，风险降低 35.4%（相对风险 0.646；95%置信区间 0.476 至 0.837）。
研究结果提供了证据表明，一些地区结核病死亡率较高且持续存在，与社会不平等有关。在这些地区推进社会政策和保护措施将有助于实现世卫组织的终结结核病战略。
