Pelissari Daniele M, Saita Nanci M, Monroe Aline A, Diaz-Quijano Fredi A
Department of Epidemiology, Postgraduate Program in Epidemiology, School of Public Health, University of São Paulo, São Paulo, SP, Brazil.
Department of Public Health, Postgraduate Program Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, SP, Brazil.
Am J Infect Control. 2022 Nov;50(11):1246-1252. doi: 10.1016/j.ajic.2022.05.015. Epub 2022 May 27.
Environmental conditions play an important role in the high incidence of tuberculosis in prisons. We estimated the effect of environmental factors, including measurements based on cell dimensions, on the time to tuberculosis diagnosis in prison population of Brazil.
This is a retrospective cohort of 2,257 prisoners diagnosed with tuberculosis in 2014 and 2015. We collected environmental data from 105 prisons and linked with routine tuberculosis surveillance and prison data. We estimated tuberculosis-free survival time with Cox risk models, guided by a validated directed acyclic graph.
The median disease-free time was 1.71 years (95% confidence interval [95% CI] 1.64-1.78). Each 50% increase in occupancy-rate, increased the tuberculosis speed incidence by 16% (95% CI 8%-25%) in the first 2 years, and 9% (95% CI 3%-16%) up to 5 years. An increase in the cell area per person (ln[m/person]) reduced the hazard of tuberculosis by 13% (95% CI 3%-23%) for up to 2, and 12% (95% CI 3%-21%) for up to 5 years.
Most tuberculosis cases were diagnosed within 2 years of incarceration. Prison overcrowding and physical space per person in the cell were associated with the tuberculosis-free disease time.
Interventions to reduce overcrowding or increase physical space are crucial to prevent tuberculosis in prisons.
环境条件在监狱结核病高发中起着重要作用。我们估计了包括基于牢房尺寸测量在内的环境因素对巴西监狱人群结核病诊断时间的影响。
这是一项对2014年和2015年被诊断患有结核病的2257名囚犯的回顾性队列研究。我们从105所监狱收集了环境数据，并将其与常规结核病监测和监狱数据相联系。在一个经过验证的有向无环图的指导下，我们用Cox风险模型估计了无结核病生存时间。
无病时间中位数为1.71年（95%置信区间[95%CI]1.64-1.78）。入住率每增加50%，在头2年结核病发病率增加16%（95%CI 8%-25%），到5年时增加9%（95%CI 3%-16%）。人均牢房面积增加（ln[m/人]），在长达2年的时间里结核病风险降低13%（95%CI 3%-23%），在长达5年的时间里降低12%（95%CI 3%-21%）。
大多数结核病病例在监禁2年内被诊断出来。监狱过度拥挤和牢房内人均物理空间与无结核病时间相关。
减少过度拥挤或增加物理空间的干预措施对于预防监狱中的结核病至关重要。
