生活条件改善对巴西肺结核死亡率的影响：一项生态学研究。
Impact of the improvement of living conditions on tuberculosis mortality in Brazil: an ecological study.
机构信息
Adjunct Professor, Department of Public Health, Institute of Collective Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
Professor, Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, United States.
出版信息
Sao Paulo Med J. 2024 Aug 26;142(6):e2023279. doi: 10.1590/1516-3180.2023.0279.R1.13052024. eCollection 2024.
BACKGROUND
The risk of death due to tuberculosis (TB) in Brazil is high and strongly related to living conditions (LC). However, epidemiological studies investigating changes in LC and their impact on TB are lacking.
OBJECTIVES
To evaluate the impact of LC on TB mortality in Brazil.
DESIGN AND SETTING
This ecological study, using panel data on spatial and temporal aggregates, was conducted in 1,614 municipalities between 2002 and 2015.
METHODS
Data were collected from the Mortality Information System and the Brazilian Institute of Geography and Statistics. The proxy variable used for LC was the Urban Health Index (UHI). Negative binomial regression models were used to estimate the effect of the UHI on TB mortality rate. Attributable risk (AR) was used as an impact measure.
RESULTS
From 2002 to 2015, TB mortality rate decreased by 23.5%, and LC improved. The continuous model analysis resulted in an RR = 0.89 (95%CI = 0.82-0.96), so the AR was -12.3%. The categorized model showed an effect of 0.92 (95%CI = 0.83-0.95) in municipalities with intermediate LC and of 0.83 (95%CI = 0.82-0.91) in those with low LC, representing an AR for TB mortality of -8.7% and -20.5%, respectively.
CONCLUSIONS
Improved LC impacted TB mortality, even when adjusted for other determinants. This impact was greater in the strata of low-LC municipalities.
背景
巴西因结核病（TB）导致的死亡风险较高，且与生活条件（LC）密切相关。然而，缺乏关于 LC 变化及其对 TB 影响的流行病学研究。
目的
评估 LC 对巴西 TB 死亡率的影响。
设计和设置
这是一项使用空间和时间聚合面板数据的生态研究，于 2002 年至 2015 年在 1614 个城市进行。
方法
数据来自死亡率信息系统和巴西地理与统计研究所。用于 LC 的代理变量是城市健康指数（UHI）。使用负二项回归模型估计 UHI 对 TB 死亡率的影响。归因风险（AR）用于衡量影响。
结果
2002 年至 2015 年间，TB 死亡率下降了 23.5%，LC 有所改善。连续模型分析得出 RR = 0.89（95%CI = 0.82-0.96），因此 AR 为-12.3%。分类模型显示，LC 处于中等水平的城市的效果为 0.92（95%CI = 0.83-0.95），LC 较低的城市的效果为 0.83（95%CI = 0.82-0.91），分别代表 AR 为-8.7%和-20.5%。
结论
LC 的改善对 TB 死亡率产生了影响，即使在调整了其他决定因素后也是如此。这种影响在 LC 较低的城市中更为显著。
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