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Tuberculosis DALY-Gap: Spatial and Quantitative Comparison of Disease Burden Across Urban Slum and Non-slum Census Tracts

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Abstract

To quantitatively assess disease burden due to tuberculosis between populations residing in and outside of urban informal settlements in Rio de Janeiro, Brazil, we compared disability-adjusted life years (DALYs), or “DALY-gap.” Using the 2010 Brazilian census definition of informal settlements as aglomerados subnormais (AGSN), we allocated tuberculosis (TB) DALYs to AGSN vs non-AGSN census tracts based on geocoded addresses of TB cases reported to the Brazilian Information System for Notifiable Diseases in 2005 and 2010. DALYs were calculated based on the 2010 Global Burden of Disease methodology. DALY-gap was calculated as the difference between age-adjusted DALYs/100,000 population between AGSN and non-AGSN. Total TB DALY in Rio in 2010 was 16,731 (266 DALYs/100,000). DALYs were higher in AGSN census tracts (306 vs 236 DALYs/100,000), yielding a DALY-gap of 70 DALYs/100,000. Attributable DALY fraction for living in an AGSN was 25.4 %. DALY-gap was highest for males 40–59 years of age (501 DALYs/100,000) and in census tracts with <60 % electricity (12,327 DALYs/100,000). DALY-gap comparison revealed spatial and quantitative differences in TB burden between slum vs non-slum census tracts that were not apparent using traditional measures of incidence and mortality. This metric could be applied to compare TB burden or burden for other diseases in mega-cities with large informal settlements for more targeted resource allocation and evaluation of intervention programs.

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Acknowledgement

Funding

MM was supported by NIH Research Training Grant #R25TW009338 (Global Health Equity Scholars Program) funded by the Fogarty International Center and the Office of AIDS Research at the National Institutes of Health. ELNM, CMMS, and TG were supported by Grant #U2RTW006885 ICOHRTA from the Secretariat of Health Surveillance/Ministry of Health of Brazil.

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Authors and Affiliations

  1. Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, 530E Li Ka Shing Health Center, Berkeley, CA, 94720, USA

    Mariel A. Marlow, Robert E. Snyder & Lee W. Riley

  2. Laboratory of Epidemiology, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil

    Ethel Leonor Noia Maciel, Carolina Maia Martins Sales & Teresa Gomes

  3. Germano Sinval Faria Teaching Primary Care Center, National School of Public Health, Oswaldo Cruz Foundation—FIOCRUZ, Rio de Janeiro, Brazil

    Regina Paiva Daumas

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  1. Mariel A. Marlow
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  2. Ethel Leonor Noia Maciel
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  3. Carolina Maia Martins Sales
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  4. Teresa Gomes
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  5. Robert E. Snyder
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  6. Regina Paiva Daumas
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  7. Lee W. Riley
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Correspondence to Mariel A. Marlow.

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Marlow, M.A., Maciel, E.L.N., Sales, C.M.M. et al. Tuberculosis DALY-Gap: Spatial and Quantitative Comparison of Disease Burden Across Urban Slum and Non-slum Census Tracts. J Urban Health 92, 622–634 (2015). https://doi.org/10.1007/s11524-015-9957-0

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  • DOI: https://doi.org/10.1007/s11524-015-9957-0

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