Tuberculosis as a marker of inequities in the context of socio-spatial transformation

Pedro, Alexandre San; Gibson, Gerusa; Santos, Jefferson Pereira Caldas dos; Toledo, Luciano Medeiros de; Sabroza, Paulo Chagastelles; Oliveira, Rosely Magalhães de

doi:10.1590/S1518-8787.2017051006533

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Articles • Rev. Saúde Pública 51 • 2017 • https://doi.org/10.1590/S1518-8787.2017051006533 copy

Tuberculosis as a marker of inequities in the context of socio-spatial transformation

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

This study aims to analyze the association between the incidence of tuberculosis and different socioeconomic indicators in a territory of intense transformation of the urban space.

METHODS

This is an ecological study, whose analysis units were the neighborhoods of the city of Itaboraí, state of Rio de Janeiro, Brazil. The data have been analyzed by generalized linear models. The response variable was incidence of tuberculosis from 2006 to 2011. The independent variables were the socio-demographic indicators. The spatial distribution of tuberculosis was analyzed with the elaboration of thematic maps.

RESULTS

The results have shown a significant association between the incidence of tuberculosis and variables that reflect different dimensions of living conditions, such as consumer goods, housing conditions and its surroundings, agglomeration of population, and income distribution.

CONCLUSIONS

The disproportionate incidence of tuberculosis in populations with worse living conditions highlights the persistence of socioeconomic determinants in the reproduction of the disease. Different municipal public sectors need to better articulate with local tuberculosis control programs to reduce the social burden of the disease.

Tuberculosis, epidemiology; Socioeconomic Factors; Health Inequalities; Social Inequity; Ecological Studies

Dimensions	Variables	Description
Consumer goods	Private vehicle	Percentage of households with private vehicle
Consumer goods	Microcomputer	Percentage of households with microcomputer
Health infrastructure	Supply of Water	Percentage of households connected to the general network of water supply and indoor plumbing in at least one room
Health infrastructure	Sewage system	Percentage of households connected to the general network of rainwater or sewage system
Housing conditions and surroundings	Coating of exterior walls	Percentage of households without coating on the external walls
	Identification of the street address	Percentage of households without identification of street address
	Open sewer	Percentage of households with open sewer in the surroundings
	Street lighting	Percentage of households without street lighting in the surroundings
	Accumulated waste	Percentage of households with accumulated waste in the surroundings
Income	Proportion of poor persons	Percentage of heads of household with income up to one minimum wage
Income	Theil Index	Inequality in income distribution of the heads of household^a
Education	Education level	Percentage of heads of household with incomplete High School
Social assistance	Social security contribution	Percentage of taxpayers with official social security in their main job or in another job
Social assistance	Government financial benefits	Percentage of beneficiaries of the Social Program Bolsa Familia or Programa de Erradicação de Trabalho Infantil (Program on the Elimination of Child Labor)
Population agglomeration	Population density	Number of inhabitants according to total usable area by km^2b
	Density of the poor	Number of heads of domicile with income up to one minimum wage according to total usable area by km²
	Density per room	Percentage of households with more than three residents per room
Migration	New immigrants	Percentage of persons who immigrated between one and two years before the 2010 Census
Migration	Old immigrants	Percentage of persons who immigrated more than ten years before the 2010 Census

Dimensions of living conditions and socioeconomic indicators	Mean	Standard deviation	Min.-Max.
Consumer goods
Households with microcomputer	29.9	11.3	7.8-66.0
Households with private vehicle	29.3	12.1	6.1-58.0
Housing conditions
Households without coating on the external walls	19.1	10.8	0-42.8
Households connected to the general sewage network	27.6	26.1	5.05-84.7
Households without identification of street address	39.8	21.4	2.7-85.4
Households with open sewer in the surroundings	16.1	14.5	0-37.8
Social assistance
Social security taxpayers	60.6	11.4	33.7-92.3
Beneficiaries of government cash transfer programs (Bolsa Família or Program on the Elimination of Child Labor)	6.9	3.5	0-15.7
Income distribution
Theil Index	0.4	0.1	0.2-0.6
Density
Density of the poor	292	271.2	20–1,084
Population density	1,834.0	1,775.8	102–6,050
Households with more than three residents per room	9.1	4.6	1.0-21.3
Migration
Migrant between one and two years before the Census	4.9	2.6	0-11.6
Migrant for more than ten years before the Census	28.3	10.1	7.3-50.9

Dimensions of living conditions and socioeconomic indicators	IRR	95%CI	p
Consumer goods
Households with microcomputer	0.73	0.55–0.98	0.03
Households with private vehicle	0.63	0.49–0.82	0.00
Availability of health infrastructure
Households connected to the general sewage network	1.64	1.48–1.81	0.00
Housing conditions and surroundings
Households without coating on the external walls	1.82	1.56–2.13	0.00
Households without identification of street address	1.25	1.08–1.45	0.00
Households with open sewer in the surroundings	1.51	1.32–1.73	0.00
Social assistance
Social security taxpayers	0.43	0.20–0.89	0.00
Beneficiaries of government cash transfer programs (Bolsa Família or Program on the Elimination of Child Labor)	2.20	1.68–2.86	0.00
Income distribution
Theil Index	1.95	1.06–3.60	0.03
Population agglomeration
Density of the poor	1.26	1.13–1.40	0.02
Population density	1.24	1.12–1.38	0.00
Households with more than three residents per room	1.69	1.35–2.09	0.00
Migration
Migrant between one and two years before the Census	1.50	1.21–1.86	0.00
Migrant for more than ten years before the Census	0.75	0.53–1.07	0.11
Multiple model
Households with private vehicles	0.46	0.35–0.60	0.00
Households with more than three residents per room	1.39	1.10–1.76	0.00
Households connected to the general sewage network	1.29	1.96–2.66	0.00
Households with open sewer in the surroundings	1.42	1.22–1.66	0.00
Density of the poor	1.20	1.08–1.34	0.00
Migrant between one and two years before the Census	1.44	1.17–1.78	0.00
Theil Index	1.98	1.05–3.73	0.00

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Alexandre San Pedro. Rua Leopoldo Bulhões, 1480 Manguinhos 21041-210 Rio de Janeiro, RJ, Brasil. E-mail: alexsan@ensp.fiocruz.br