Determinants associated with areas with higher tuberculosis mortality rates: an ecological study

OBJECTIVE: To characterize tuberculosis deaths in a region of northeast Brazil during the period from 2006 to 2017 and to identify determinants associated with areas with higher tuberculosis mortality rates.

METHODS: Ecological descriptive study of deaths from tuberculosis with multivariate mapping and logistic regression, carried out from 2006 to 2017 in the 75 municipalities of Sergipe, Brazil. The focus of the analysis was the mean mortality rate from tuberculosis, dichotomized according to the median. The independent variables were selected based on the conceptual model of the social determinants of health.

RESULTS: Mortality due to tuberculosis in Sergipe, Brazil was most prevalent among males, mixed-race people, people over 40 years old and with a low level of education. Multivariate logistic regression identified the mean incidence rate for tuberculosis (aOR: 1.06), the proportion of HIV testing (aOR: 7.10), people without primary education and with informal occupation (aOR: 1.26) and people living in urban households without waste collection service (aOR: 0.10) as determinants associated to municipalities with higher tuberculosis mortality rates, with area under the ROC curve of 84% (p-value 0.000). Mapping revealed evident spatial variability.

CONCLUSIONS: The tuberculosis epidemic in Brazil is determined by access to health services, especially the provision of HIV testing among those diagnosed with tuberculosis, accelerated urbanization with large pockets of poverty, and unsanitary housing conditions, corroborating global trends.