Tuberculosis in the Brazilian imprisoned population, 2007-2013*

Macedo, Laylla Ribeiro; Maciel, Ethel Leonor Noia; Struchiner, Claudio José

doi:10.5123/S1679-49742017000400010

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Epidemiologia e Serviços de Saúde

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Original article • Epidemiol. Serv. Saúde 26 (4) • Oct-Dec 2017 • https://doi.org/10.5123/S1679-49742017000400010 copy

Tuberculosis in the Brazilian imprisoned population, 2007-2013^* * Article based on the PhD thesis by Laylla Ribeiro Macedo, entitled ‘Tuberculosis in vulnerable populations: factors associated to illness and treatment outcome’, to be defended at the Post-graduation Program in Epidemiology and Public Health, of the National School of Public Health Sergio Arouca, of Oswaldo Cruz Institute, in 2018.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

OBJECTIVE:

to describe socio-demographic and clinical characteristics and indicators of tuberculosis (TB) in Brazilian imprisoned population, from 2007 to 2013.

METHODS:

descriptive study with data from the Information System for Notifiable Diseases (Sinan).

RESULTS:

from 2007 to 2013, 38,083 TB cases were reported in the imprisoned population, equivalent to a TB prevalence of 1,236 cases/100,000 individuals; this prevalence was higher among women (1,693/100,000), indigenous people (2,874/100,000), and in the age group >60 years (4,093/100,000); there were mainly reports of cases of pulmonary TB (91.5%) and new cases (78.1%); the TB incidence rate in 2013 (904.9/100,000) was higher than 2007 (627.6/100,000), whilst the mortality rate in 2013 (16.0/100,000) was lower than 2007 (18.0/100,000).

CONCLUSION:

TB in the imprisoned population presents some specific characteristics and higher occurrence than in the general population; the highest prevalence in women and the highest incidence at the end of the study period stood out.

Keywords:
Tuberculosis; Prisons; Epidemiology, Descriptive

Cases selection	2007	2008	2009	2010	2011	2012	2013	Total
Total TB cases in Brazil	87,919	90,059	88,135	88,107	90,254	85,428	88,368	619,270
Total TB cases among inmates	3,551	4,426	5,556	5,800	6,237	6,410	7,103	39,083
Cases excluded due to diagnosis change	38	43	50	49	51	70	75	376
TB cases confirmed among inmates	3,513	4,383	5,506	5,751	6,186	6,340	7,028	38,707
Cases excluded due to age (<18 years)	70	87	92	94	78	83	120	624
Cases included into the study	3,443	4,296	5,414	5,657	6,108	6,257	6,908	38,083

Characteristics	2007		2008		2009		2010		2011		2012		2013		Total
Characteristics	N	Prevalence	N	Prevalence	N	Prevalence	N	Prevalence	N	Prevalence	N	Prevalence	N	Prevalence	N	Prevalence
Sex
Female	372	1,954	413	1,912	434	1,787	463	1,643	480	1,636	485	1,533	515	1,577	3,162	1,693
Male	3,071	884	3,883	1,044	4,980	1,268	5,194	1,244	5,628	1,274	5,772	1,197	6,393	1,266	34,921	1,180
Ethnicity/skin color
White	1,117	813	1,461	991	1,997	1,279	1,957	1,250	2,078	1,249	2,098	1,209	2,258	1,282	12,966	1,164
Black	504	850	617	927	774	1,113	780	1,107	732	965	765	926	898	1,040	5,070	993
Asian	17	761	39	1,427	73	3,603	43	2,144	45	2,064	28	1,210	23	835	268	1,649
Brown	1,139	810	1,412	937	1,802	1,055	2,127	1,166	2,481	1,252	2,702	1,272	3,071	1,387	14,734	1,154
Indigenous	19	3,525	10	1,957	21	4,031	27	3,610	18	2,341	21	2,479	19	2,490	135	2,874
Unknown/blank	647	-	757	-	747	-	723	-	754	-	643	-	639	-	4,910	-
Education level (in years of schooling)
Illiterate	105	353	125	440	156	598	146	577	157	594	174	626	176	641	1,039	543
1-4	894	1,708	947	2,015	1,005	2,029	1,004	1,800	1,168	2,001	1,151	1,796	1,127	1,719	7,296	1,858
5-8	975	471	1,071	482	1,296	527	322	126	2,195	796	2,673	1,027	2,414	801	10,946	619
>8	244	381	363	477	364	456	478	561	968	1,020	560	550	1,185	1,108	4,162	683
Unknown/blank	1,225	-	1,790	-	2,593	-	2,707	-	1,620	-	1,699	-	2,006	-	13,640	-
Age group (in years)
18-35	2,437	927	3,102	1,077	4,008	1,288	4,149	1,321	4,479	1,330	4,625	1,287	5,110	1,384	27,910	1,245
36-59	841	1,118	1,022	1,268	1,243	1,429	1,335	1,401	1,433	1,361	1,447	1,249	1,612	1,348	8,933	1,316
≥60	165	4,934	172	5,168	163	3,999	173	3,983	196	4,042	185	3,667	187	3,506	1,241	4,093
Total	13,772	968	17,184	1105	21,656	1,314	21,628	1,247	24,432	1,317	25,028	1,275	27,633	1,341	151,333	1,236

Characteristics	2007		2008		2009		2010		2011		2012		2013		Total
Characteristics	N	%	N	%	N	%	N	%	N	%	N	%	N	%	N	%
Tuberculosis type
Pulmonary	3,095	89.9	3,842	89.5	4,943	91.3	5,167	91.3	5,610	91.8	5,749	91.9	6,426	93.0	34,833	91.5
Estrapulmonary	250	7.3	328	7.6	351	6.5	358	6.4	372	6.1	374	6.0	370	5.4	2,403	6.3
Pulmonary + extrapulmonary	98	2.8	126	2.9	120	2.3	131	2.3	126	2.1	134	2.1	112	1.6	847	2.2
Type of entry
New case	2,652	77.0	3,338	77.7	4,294	79.3	4,492	79.4	4,765	78.0	4,941	79.0	5,262	76.2	29,744	78.1
Recurrence	326	9.5	401	9.3	477	8.8	524	9.3	666	10.9	683	10.9	779	11.3	3,856	10.1
Return after dropout	249	7.2	317	7.4	415	7.7	418	7.4	421	6.9	446	7.1	658	9.5	2,924	7.7
Unknown	11	0.3	09	0.2	11	0.2	12	0.2	10	0.2	15	0.2	26	0.4	94	0.2
Referral	205	6.0	231	5.4	217	4.0	211	3.7	246	4.0	172	2.8	183	2.6	1,465	3.8
Closure	105	353	125	440	156	598	146	577	157	594	174	626	176	641	1,039	543
Cure	1,983	57.6	2,565	59.7	3,816	70.5	4,017	71.0	4,474	73.2	4,470	71.3	4,799	69.5	26,124	68.6
Dropout	364	10.6	475	11.1	663	12.3	630	11.1	638	10.4	655	10.5	659	9.5	4,084	10.7
Death due to tuberculosis	76	2.2	69	1.6	79	1.5	77	1.4	79	1.3	73	1.3	93	1.3	546	1.4
Death due to other causes	97	2.8	104	2.4	146	2.7	158	2.8	152	2.5	134	2.1	143	2.1	934	2.5
Referral	350	10.2	375	8.7	489	9.0	466	8.2	567	9.3	513	8.2	581	8.4	3,341	8.8
Multidrug-resistant tuberculosis	7	0.2	7	0.2	24	0.4	16	0.3	29	0.5	20	0.3	24	0.4	127	0.3
Unknown/blank	566	16.4	701	16.3	197	3.6	293	0.3	169	2.8	392	6.3	609	8.8	2,927	7.7

Indicators	2007		2008		2009		2010		2011		2012		2013			Total
Indicators	N^a D ^b	%	N^a D ^b	%	N^a D ^b	%	N^a D ^b	%	N^a D ^b	%	N^a D ^b	%	N^a D ^b	%	N^a D ^b	%
Proportion of TB cases^c tested for HIV^d	1,408/3,443	40.9	2,011/4,296	46.8	3,182/5,414	58.8	3,578/5,657	63.2	3,972/6,108	65.0	4,179/6,257	66.8	4,942/6,908	71.5	23,272/38,083	61.1
Proportion of TB^c-HIV^dcoinfection	266/2,652	10.0	338/3,338	10.1	411/4,294	9.6	444/4,492	9.9	449/4,765	9.4	409/4,941	8.3	436/5,262	8.3	2,753/29,744	9.3
Proportion of TB cases^c who underwent DOT^e	1,576/2,652	59.4	1,585/3,338	47.5	2,427/4,294	56.5	2,977/4,492	66.3	3,241/4,765	68.0	3,589/4,941	72.6	2,746/5,262	52.2	18,141/29,744	61.0
Proportion of TB^c retreatment cases	575/2,652	21.7	718/3,338	21.5	892/4,294	20.8	942/4,492	21.0	1,097/4,765	22.8	1,129/4,941	22.8	1,437/5,262	27.3	6,780/29,744	22.8
Proportion of TB^c cured cases	1,983/3,443	57.6	2,565/4,296	59.7	3,816/5,414	70.5	4,017/5,657	71.0	4,474/6,108	73.2	4,470/6,257	71.4	4,799/6,908	69.5	26,124/38,083	68.6
Proportion of TB^c dropout cases	364/3,443	10.6	475/4,296	11.1	663/5,414	12.2	630/5,657	11.1	638/6,108	10.4	655/6,257	10.5	659/6,908	9.5	4,084/38,083	10.7
Proportion of TB^c cases closed due to death	173/3,443	5.0	173/4,296	4.0	225/5,414	4.1	235/5,657	4.1	231/6,108	3.8	207/6,257	3.3	236/6,908	3.4	1,480/38,083	3.9
Proportion of TB^c cases with informed closure	2,251/2,652	84.9	2,831/3,338	84.8	4,152/4,294	96.7	4,283/4,492	95.3	4,635/4,765	97.2	4,639/4,941	93.9	4,859/5,262	92.3	27,650/29,744	92.9

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[1] Correspondence: Laylla Ribeiro Macedo - Rua Professor Hernani Pires de Melo, No. 80, apto. 801, Bairro São Domingos, Niterói-RJ, Brasil. CEP: 24210-130 E-mail: layllarm@hotmail.com