César V Munayco1, Oscar J Mújica2, Francisco X León3, Mirtha del Granado3, Marcos A Espinal4. 1. Department of Preventive Medicine and Biometrics, Uniformed Services, University of the Health Sciences, Bethesda, Maryland, United States of America, cesar.munayco@usuhs.edu. 2. Social Epidemiology, Special Program on Sustainable Development and Health Equity, Pan American Health Organization, World Health Organization, Washington DC, United States of America. 3. HIV, Hepatitis, Tuberculosis, and Sexually-transmitted Infections Unit, Communicable Diseases and Health Analysis Department, PAHO, WHO, Washington DC, United States of America. 4. Communicable Diseases and Health Analysis Department, PAHO, WHO, Washington, DC, United States of America.
Abstract
OBJECTIVE: To identify key social determinants of tuberculosis (TB) incidence among countries in Latin America and the Caribbean (LAC), a geographic area regarded as one of the most socioeconomically unequal in the world METHODS: An ecological study was conducted at the country level. Data were obtained from several institutional-based sources. Random-effects regression modeling was used to explore the relationship between several social determinants indicators and TB incidence rates in 20 LAC countries in 1995-2012. Standard gap and gradient metrics of social inequality in TB incidence among countries in 2000, 2005, and 2010 were then calculated. RESULTS: TB incidence rate trends were significantly associated with health expenditure per capita and access to improved sanitation facilities, as well as with life expectancy at birth and TB detection rate, after adjusting for other socioeconomic, demographic, and health services variables. Absolute and relative inequality in TB incidence remained mostly unchanged: countries at the bottom 20% of both health expenditure and sanitation coverage distributions concentrated up to 40% of all TB incident cases, despite a considerable decline in the overall TB incidence mean rate during the period assessed. CONCLUSIONS: Along with the intensity of TB control (reflected by TB detection rate), both access to sanitation (as a proxy of quality of living conditions) and health expenditure per capita (either as an indicator of the level of resources and/or commitment to health care) appear to be key determinants of TB incidence trends in LAC countries. Inequalities in both health expenditure per capita and access to sanitation seem to define profound and persistent inverse gradients in TB incidence among LAC countries.
OBJECTIVE: To identify key social determinants of tuberculosis (TB) incidence among countries in Latin America and the Caribbean (LAC), a geographic area regarded as one of the most socioeconomically unequal in the world METHODS: An ecological study was conducted at the country level. Data were obtained from several institutional-based sources. Random-effects regression modeling was used to explore the relationship between several social determinants indicators and TB incidence rates in 20 LAC countries in 1995-2012. Standard gap and gradient metrics of social inequality in TB incidence among countries in 2000, 2005, and 2010 were then calculated. RESULTS: TB incidence rate trends were significantly associated with health expenditure per capita and access to improved sanitation facilities, as well as with life expectancy at birth and TB detection rate, after adjusting for other socioeconomic, demographic, and health services variables. Absolute and relative inequality in TB incidence remained mostly unchanged: countries at the bottom 20% of both health expenditure and sanitation coverage distributions concentrated up to 40% of all TB incident cases, despite a considerable decline in the overall TB incidence mean rate during the period assessed. CONCLUSIONS: Along with the intensity of TB control (reflected by TB detection rate), both access to sanitation (as a proxy of quality of living conditions) and health expenditure per capita (either as an indicator of the level of resources and/or commitment to health care) appear to be key determinants of TB incidence trends in LAC countries. Inequalities in both health expenditure per capita and access to sanitation seem to define profound and persistent inverse gradients in TB incidence among LAC countries.
Authors: Marcos Augusto Moraes Arcoverde; Thais Zamboni Berra; Luana Seles Alves; Danielle Talita Dos Santos; Aylana de Sousa Belchior; Antônio Carlos Vieira Ramos; Luiz Henrique Arroyo; Ivaneliza Simionato de Assis; Josilene Dália Alves; Ana Angélica Rêgo de Queiroz; Mellina Yamamura; Pedro Fredemir Palha; Francisco Chiaravalloti Neto; Reinaldo Antonio Silva-Sobrinho; Oscar Kenji Nihei; Ricardo Alexandre Arcêncio Journal: BMC Public Health Date: 2018-06-26 Impact factor: 3.295
Authors: Carlos Dornels Freire de Souza; João Paulo Silva de Paiva; Leonardo Feitosa da Silva; Thiago Cavalcanti Leal; Mônica de Avelar Figueiredo Mafra Magalhães Journal: J Bras Pneumol Date: 2019-04-25 Impact factor: 2.624
Authors: Mary F Reyes-Vega; M Gabriela Soto-Cabezas; Fany Cárdenas; Kevin S Martel; Andree Valle; Juan Valverde; Margot Vidal-Anzardo; María Elena Falcón; César V Munayco Journal: EClinicalMedicine Date: 2021-03-30
Authors: Daniel Barros de Castro; Elvira Maria Godinho de Seixas Maciel; Megumi Sadahiro; Rosemary Costa Pinto; Bernardino Cláudio de Albuquerque; José Ueleres Braga Journal: Int J Equity Health Date: 2018-12-29