Social determinants of pulmonary tuberculosis in Argentina

In Argentina, approximately 9,000 new cases of tuberculosis (TB) are recorded every year, representing an incidence rate of 22 cases per 100,000 inhabitants. There are no reported studies in Argentina examining the factors that influence the unequal distribution of the disease. The aim of the study was to identify the relationship between the distribution of social and economic factors and TB in Argentina between 2008 and 2012.

Method:

An ecologic study involving 525 departmental jurisdictions was conducted. Simple linear regression analysis was performed, followed by multiple linear regression for each group of determinants. A final model of determinants of TB’s incidence was constructed from a model of multiple linear regression.

Results:

The following determinants explain 43% of the variability of TB’s incidence rate among different jurisdictions: overcrowding, proportion of households with a sewage network, proportion of examined patients with respiratory symptoms and proportion of patients who discontinued treatment.

Discussion:

This study makes an important contribution to a better understanding of the factors influencing the TB occurrence in Argentina, which is the result of a multidimensional and complex process. Thesefactors make part of this disease’s social determination.

Conclusion:

TB incidence is associated with different determinants, from multiple levels. Inequalities in its distribution in Argentina are driven by the unequal distribution of key social determinants.

Keywords:
Tuberculosis; Epidemiology; Socioeconomic factors

Determinants	Average	Regression coefficient¹	95%CI	p-value	Regression coefficient adjusted²	95%CI	p-value
Level 1
Proportion households with Unsatisfied Basic Needs Index (UBNI)	12,3	0,828	(0,637 - 1,019)	0,000	0,828	(0,637 - 1,019)	< 0.001
Level 2
Proportion of illiterates	8,4	1,329	(0,801 - 1,856)	0,000
Proportion of households with overcrowding	4,9	2,431	(1,993 - 2,870)	0,000	3,010	(2,552 - 3,468)	< 0.001
Proportion of population with unemployment	5,1	0,699	(-0,199 - 1,958)	0,127
Proportion of urban population	75,0	0,019	(-0,074 - 0,112)	0,688
Proportion of substandard housing	7,3	0,612	(0,426 - 0,798)	0,000
Proportion of households using solid fuels	7,7	0,295	(0,189 - 0,402)	0,000
Proportion of households with drinking water	77,6	-0,037	(-0,122 - 0,046)	0,381
Proportion of households with sewer service	35,7	0,039	(-0,015 - 0,094)	0,160	0,169	(0,117 - 0,221)	< 0.001

Determinants	Average	Regression Coefficient¹	95%CI	p-value	Regression Coefficient adjusted²	95%CI	p-value
Proportion of patients with respiratory symptoms	0,46	14,775	(12,050 - 17,500)	0,000	13,523	(10,965 - 16,081)	< 0.001
TB Proportion of patients evaluated	58,4	0,127	(0,085 - 0,170)	0,000
Proportion of patients with successful TB treatment	57,5	0,130	(0,085 - 0,175)	0,000
Proportion of patients TB abandoned treatment	8,5	0,410	(0,295 - 0,526)	0,000	0,379	(0,247 - 0,511)	< 0.001
Proportion of patients with TB TDO	49,5	0,099	(0,058 - 0,140)	0,000
Proportion of population with private health coverage	56,6	-30,101	(-41,313- -18,889)	0,000	-29,632	(-41,949 - 17,316)	< 0.001
Laboratories coverage per 10,000 population.	0,85	-0,869	(-3,543 - 1,844)	0,523
APS coverage per 10,000 population	1,1	-0,157	(-1,252 - 0,937)	0,778

Determinants	Average	Regression Coefficient¹	95%CI	p-value	Regression Coefficient adjusted²	95%CI	p-value
Proportion households with UBNI	12,3	0,828	(0,637 - 1,019)	0,000
Proportion of households with overcrowding	4,9	3,010	(2,552 - 3,468)	0,000	2,372	(1,875 - 2,869)	< 0.001
Proportion of households with sewer service	35,7	0,169	(0,117 - 0,221)	0,160	0,091	(0,031 - 0,151)	0,003
Proportion of patients with respiratory symptoms	0,46	13,523	(10,965 - 16,081)	0,000	10,611	(8,114 - 13,108)	< 0.001
TB proportion of patients who left treatment	8,5	0,379	(0,247 - 0,511)	0,000	0,363	(0,242 - 0,484)	< 0.001
Proportion of population with private health coverage	56,6	-29,632	(-41,949- -17,316)	0,000

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[1] Corresponding author: Jose Ueleres Braga. Rua São Francisco Xavier, 524, Pavilhão João Lyra Filho, 7º andar / blocos D e E, e 6º andar / bloco E, Maracanã, CEP 20550-013, Rio de Janeiro, RJ, Brazil. E-mail: ueleres@gmail.com