Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal.
ICVS/3B, PT Government Associate Laboratory, University of Minho, 4710-057, Braga, Portugal.
Infect Dis Poverty. 2022 Mar 24;11(1):24. doi: 10.1186/s40249-022-00949-1.
Multidrug resistant tuberculosis (MDR-TB) is a recognized threat to global efforts to TB control and remains a priority of the National Tuberculosis Programs. Additionally, social determinants and socioeconomic deprivation have since long been associated with worse health and perceived as important risk factors for TB. This study aimed to analyze the spatial distribution of non-MDR-TB and MDR-TB across parishes of the Lisbon metropolitan area of Portugal and to estimate the association between non-MDR-TB and MDR-TB and socioeconomic deprivation.
In this study, we used hierarchical Bayesian spatial models to analyze the spatial distribution of notification of non-MDR-TB and MDR-TB cases for the period from 2000 to 2016 across 127 parishes of the seven municipalities of the Lisbon metropolitan area (Almada, Amadora, Lisboa, Loures, Odivelas, Oeiras, Sintra), using the Portuguese TB Surveillance System (SVIG-TB). In order to characterise the populations, we used the European Deprivation Index for Portugal (EDI-PT) as an indicator of poverty and estimated the association between non-MDR-TB and MDR-TB and socioeconomic deprivation.
The notification rates per 10,000 population of non-MDR TB ranged from 18.95 to 217.49 notifications and that of MDR TB ranged from 0.83 to 3.70. We identified 54 high-risk areas for non-MDR-TB and 13 high-risk areas for MDR-TB. Parishes in the third [relative risk (RR) = 1.281, 95% credible interval (CrI): 1.021-1.606], fourth (RR = 1.786, 95% CrI: 1.420-2.241) and fifth (RR = 1.935, 95% CrI: 1.536-2.438) quintile of socioeconomic deprivation presented higher non-MDR-TB notifications rates. Parishes in the fourth (RR = 2.246, 95% CrI: 1.374-3.684) and fifth (RR = 1.828, 95% CrI: 1.049-3.155) quintile of socioeconomic deprivation also presented higher MDR-TB notifications rates.
We demonstrated significant heterogeneity in the spatial distribution of both non-MDR-TB and MDR-TB at the parish level and we found that socioeconomically disadvantaged parishes are disproportionally affected by both non-MDR-TB and MDR-TB. Our findings suggest that the emergence of MDR-TB and transmission are specific from each location and often different from the non-MDR-TB settings. We identified priority areas for intervention for a more efficient plan of control and prevention of non-MDR-TB and MDR-TB.
耐多药结核病（MDR-TB）是全球结核病控制工作的公认威胁，仍然是国家结核病规划的重点。此外，社会决定因素和社会经济贫困长期以来一直与较差的健康状况相关，并被视为结核病的重要危险因素。本研究旨在分析葡萄牙里斯本大都市区 127 个教区的非耐多药结核病和耐多药结核病的空间分布，并估计非耐多药结核病和耐多药结核病与社会经济贫困之间的关联。
在这项研究中，我们使用分层贝叶斯空间模型来分析 2000 年至 2016 年期间，来自里斯本大都市区七个城市（阿尔马达、阿马多拉、里斯本、洛雷什、奥埃拉斯、奥伊拉斯、辛特拉）的 127 个教区的非耐多药结核病和耐多药结核病病例的通知率，使用葡萄牙结核病监测系统（SVIG-TB）。为了描述人群特征，我们使用葡萄牙贫困指数（EDI-PT）作为贫困的指标，并估计了非耐多药结核病和耐多药结核病与社会经济贫困之间的关联。
非耐多药结核病的每 10000 人口通知率范围为 18.95 至 217.49 例，耐多药结核病的通知率范围为 0.83 至 3.70。我们确定了 54 个非耐多药结核病高风险地区和 13 个耐多药结核病高风险地区。处于社会经济贫困第三（相对风险（RR）=1.281，95%置信区间（CrI）：1.021-1.606）、第四（RR=1.786，95% CrI：1.420-2.241）和第五（RR=1.935，95% CrI：1.536-2.438）五分位数的教区报告了更高的非耐多药结核病通知率。处于社会经济贫困第四（RR=2.246，95% CrI：1.374-3.684）和第五（RR=1.828，95% CrI：1.049-3.155）五分位数的教区也报告了更高的耐多药结核病通知率。
我们在教区一级证明了非耐多药结核病和耐多药结核病的空间分布存在显著异质性，并且发现社会经济处于不利地位的教区受到非耐多药结核病和耐多药结核病的不成比例影响。我们的研究结果表明，耐多药结核病的出现和传播具有特定的位置特异性，并且通常与非耐多药结核病的情况不同。我们确定了干预的优先领域，以制定更有效的非耐多药结核病和耐多药结核病控制和预防计划。
