Spatial analysis of the tuberculosis treatment dropout, Buenos Aires, Argentina

Herrero, María Belén; Arrossi, Silvina; Ramos, Silvina; Braga, Jose Ueleres

doi:10.1590/S0034-8910.2015049005391

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Original Articles • Rev. Saúde Pública 49 • 2015 • https://doi.org/10.1590/S0034-8910.2015049005391 copy

Spatial analysis of the tuberculosis treatment dropout, Buenos Aires, Argentina

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

Identify spatial distribution patterns of the proportion of nonadherence to tuberculosis treatment and its associated factors.

METHODS

We conducted an ecological study based on secondary and primary data from municipalities of the metropolitan area of Buenos Aires, Argentina. An exploratory analysis of the characteristics of the area and the distributions of the cases included in the sample (proportion of nonadherence) was also carried out along with a multifactor analysis by linear regression. The variables related to the characteristics of the population, residences and families were analyzed.

RESULTS

Areas with higher proportion of the population without social security benefits (p = 0.007) and of households with unsatisfied basic needs had a higher risk of nonadherence (p = 0.032). In addition, the proportion of nonadherence was higher in areas with the highest proportion of households with no public transportation within 300 meters (p = 0.070).

CONCLUSIONS

We found a risk area for the nonadherence to treatment characterized by a population living in poverty, with precarious jobs and difficult access to public transportation.

Tuberculosis; drug therapy; Medication Adherence; Socioeconomic Factors; Health Inequalities; Ecological Studies

Characteristic	Existence (%)
	AB	AV	BZ	EE	EZ	LZ	QM	Total

	%	%	%	%	%	%	%	%
Area and residences characteristics
Electricity per household	96.0	100	98.3	98.9	97.5	98.7	95.3	97.2
Paved Street	73.0	100	75.4	72.4	78.2	87.2	72.8	76.1
Waterwaste and sewage treatment system	13.0	85.3	73.8	4.9	2.0	6.7	59.0	37.5
Garbage collection service	87.3	100	95.3	89.8	97.2	92.9	88.7	91.5
Gas pipeline network	63.6	97.8	87.9	64.0	62.0	75.3	69.7	72.2
Electrical power installation	44.5	100	99.7	41.3	30.1	89.3	92.7	74.4
Deprived dwelling	34.8	2.4	23.1	38.0	39.3	31.0	30.0	30.7
Ceramic floors, flag stone or mosaic	48.1	75.8	56.2	41.3	38.4	53.0	52.5	50.4
Water supply in the residence	64.3	76.7	78.7	58.7	52.3	69.1	74.2	69.0
Public transportation within 300 m	90.2	100	89.9	85.2	81.8	89.9	84.9	87.2
Characteristics of households and population
Kitchen with piped water	62.0	77.5	75.2	56.0	48.7	68.4	71.2	66.1
Microwave oven	9.8	27.7	14.1	10.6	9.1	10.1	14.2	12.4
Overcrowding	7.1	10.2	5.8	7.2	8.7	6.3	5.9	6.4
Water-closet without flushing system or without water-closet	28.6	0.7	17.6	31.1	32.1	25.0	23.1	24.4
Refrigerator (with or without freezer)	81.8	77.6	85.1	81.0	76.5	82.0	82.4	81.9
Computer (with or without Internet)	8.9	23.6	13.7	10.1	9.2	9.7	12.5	11.6
Literate population	84.1	91.7	85.3	83.9	83.3	86.7	85.8	85.2
Population without health insurance	63.7	33.0	57.8	63.2	62.7	63.7	54.8	59.0
Telephone (landline, mobile or both)	53.1	69.5	58.3	53.9	49.0	54.8	54.4	54.8
No material deprivation in the residences	34.7	65.7	43.6	33.9	31.6	38.7	41.5	39.3
With material deprivation in the residences	21.4	0.2	16.1	21.7	23.2	19.7	19.0	19.2
With at least a UBN indicator	20.7	4.4	17.2	19.3	20.2	18.8	23.0	19.9
With UBN per subsistence condition	7.0	1.4	6.2	4.9	5.8	18.3	21.1	11.8
With one spouse unemployed or inactive	50.8	50.1	48.2	53.0	52.7	48.7	49.9	50.3
Population that contributes to or receives retirement funds	12.6	27.7	15.2	13.0	13.6	13.2	17.3	15.1
Unemployed population	17.5	12.3	18.7	16.0	14.5	19.8	17.3	17.3

Characteristic	Correlation coefficient (ρ =)	p
Refrigerator or freezer	0.17	0.194
Contribution to retirement: do not contribute or do not receive salary	0.21	0.104
UBN indicator of subsistence conditions	0.26	0.048
Public transportation within 300 m (3 blocks)	0.21	0.104
Water-closet without flushing system or without water-closet	0.17	0.200
Population between 15 and 64 years	0.15	> 0.20
Illiterate population	0.06	> 0.20
Piped water	0.15	> 0.20
Condition: unemployed	0.05	> 0.20
Population without health insurance	0.05	> 0.20
Water supply in the residence	0.14	> 0.20
Washing machine or washing tank	0.15	> 0.20
With at least a UBN indicator	0.07	> 0.20
Level of education: Incomplete Elementary School	0.13	> 0.20

Characteristic	Regression coefficient adj	95%CI	p
Contribution to retirement: do not contribute nor receive it	1,068.21	300.35;1836.07	0.007
UBN indicator of subsistence conditions	145.18	12.56;277.79	0.032
Public transportation within 300 m	103.06	-8.70;214.81	0.070

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[1] Correspondence:José Ueleres Braga. Departamento de Epidemiologia e Métodos Quantitativos – Fiocruz. Pavilhão João Lyra Filho. Rua São Francisco Xavier, 524 7º andar, blocos D/E, 6º andar, bloco E Maracanã. 20550-013 Rio de Janeiro, RJ, Brasil. E-mail: ueleres@gmail.com