M G Jacobs1, D M Pelissari2, V L Pinto3. 1. Department of Public Health, Faculty of Health Sciences, University of Brasília, Brasília, Distrito Federal. 2. Department of Epidemiology, Faculty of Public Health, University of São Paulo, São Paulo, São Paulo. 3. Department of Epidemiology and Health Surveillance, Oswaldo Cruz Foundation, Brasília, Distrito Federal, Brazil.
Abstract
SETTING: The selection and transmission of drug-resistant strains of tuberculosis (TB) hamper disease control. OBJECTIVE: To identify health conditions, demographic and socio-economic factors, as well as individual factors associated with the incidence of drug-resistant TB (DR-TB), in Brazil at the municipal level. DESIGN: This was an ecological study covering Brazilian municipalities that had reported DR-TB cases in 2014. Associations were evaluated in a multilevel analysis using negative binomial regression. RESULTS: In the multilevel model, males (incidence rate ratio [IRR] 2.6, 95% confidence interval [CI] 2.3-2.93) and Black persons (IRR 1.82, 95%CI 1.61-2.05) had a higher risk of DR-TB. Compared with those aged 60 years, persons aged 15-59 years (IRR 1.72, 95%CI 1.40-2.11) also had a higher risk. The following contextual factors were associated with the incidence rate (IR) of DR-TB: proportion of previously treated patients (IRR 1.27, 95%CI 1.1-1.5), acquired immune-deficiency syndrome IR (IRR 1.13, 95%CI 1.02-1.25), Municipal Human Development Index (IRR 0.72, 95%CI 0.64-0.81) and the Gini coefficient (IRR 0.86, 95%CI 0.78-0.95). CONCLUSION: We have identified individual and contextual factors associated with the incidence of DR-TB. Our results may help improve integrated public health interventions aimed at controlling DR-TB in Brazil.
SETTING: The selection and transmission of drug-resistant strains of tuberculosis (TB) hamper disease control. OBJECTIVE: To identify health conditions, demographic and socio-economic factors, as well as individual factors associated with the incidence of drug-resistant TB (DR-TB), in Brazil at the municipal level. DESIGN: This was an ecological study covering Brazilian municipalities that had reported DR-TB cases in 2014. Associations were evaluated in a multilevel analysis using negative binomial regression. RESULTS: In the multilevel model, males (incidence rate ratio [IRR] 2.6, 95% confidence interval [CI] 2.3-2.93) and Black persons (IRR 1.82, 95%CI 1.61-2.05) had a higher risk of DR-TB. Compared with those aged 60 years, persons aged 15-59 years (IRR 1.72, 95%CI 1.40-2.11) also had a higher risk. The following contextual factors were associated with the incidence rate (IR) of DR-TB: proportion of previously treated patients (IRR 1.27, 95%CI 1.1-1.5), acquired immune-deficiency syndrome IR (IRR 1.13, 95%CI 1.02-1.25), Municipal Human Development Index (IRR 0.72, 95%CI 0.64-0.81) and the Gini coefficient (IRR 0.86, 95%CI 0.78-0.95). CONCLUSION: We have identified individual and contextual factors associated with the incidence of DR-TB. Our results may help improve integrated public health interventions aimed at controlling DR-TB in Brazil.
Authors: Kevin Montes; Himachandana Atluri; Hibeb Silvestre Tuch; Lucrecia Ramirez; Juan Paiz; Ana Hesse Lopez; Thomas C Bailey; Andrej Spec; Carlos Mejia-Chew Journal: J Clin Tuberc Other Mycobact Dis Date: 2021-11-15