The online version of this article (https://doi.org/10.1186/s12916-018-1131-6) contains supplementary material, which is available to authorized users.
Brazil has high burdens of tuberculosis (TB) and HIV, as previously estimated for the 26 states and the Federal District, as well as high levels of inequality in social and health indicators. We improved the geographic detail of burden estimation by modelling deaths due to TB and HIV and TB case fatality ratios for the more than 5400 municipalities in Brazil.
This ecological study used vital registration data from the national mortality information system and TB case notifications from the national communicable disease notification system from 2001 to 2015. Mortality due to TB and HIV was modelled separately by cause and sex using a Bayesian spatially explicit mixed effects regression model. TB incidence was modelled using the same approach. Results were calibrated to the Global Burden of Disease Study 2016. Case fatality ratios were calculated for TB.
There was substantial inequality in TB and HIV mortality rates within the nation and within states. National-level TB mortality in people without HIV infection declined by nearly 50% during 2001 to 2015, but HIV mortality declined by just over 20% for males and 10% for females. TB and HIV mortality rates for municipalities in the 90th percentile nationally were more than three times rates in the 10th percentile, with nearly 70% of the worst-performing municipalities for male TB mortality and more than 75% for female mortality in 2001 also in the worst decile in 2015. The same municipality ranking metric for HIV was observed to be between 55% and 61%. Within states, the TB mortality rate ratios by sex for municipalities in the worst decile versus the best decile varied from 1.4 to 2.9, and HIV varied from 1.4 to 4.2. The World Health Organization target case fatality rate for TB of less than 10% was achieved in 9.6% of municipalities for males versus 38.4% for females in 2001 and improved to 38.4% and 56.6% of municipalities for males versus females, respectively, by 2014.
Mortality rates in municipalities within the same state exhibited nearly as much relative variation as within the nation as a whole. Monitoring the mortality burden at this level of geographic detail is critical for guiding precision public health responses.
Additional file 1: Data sources, model equations and validation, and additional tables and figures. (DOCX 1360 kb)12916_2018_1131_MOESM1_ESM.docx
World Health Organization. Global Tuberculosis Report 2017. Geneva: WHO; 2017.
World Health Organization. World AIDS Day Around the World. http://www.who.int/campaigns/aids-day/2017/en/. Accessed 26 Jan 2018
Snyder RE, Jaimes G, Riley LW, Faerstein E, Corburn J. A comparison of social and spatial determinants of health between formal and informal settlements in a large metropolitan setting in Brazil. J Urban Health Bull N Y Acad Med. 2014;91:432–45. CrossRef
de Almeida Wda S, Szwarcwald CL. Infant mortality and geographic access to childbirth in Brazilian municipalities. Rev Saude Publica. 2012;46:68–76. CrossRef
Ferreira DN, Matos DL, de Loyola Filho AI. Absence of routine medical consultation among hypertensive and/or diabetic elders: an epidemiological study based on the Brazilian National Household Survey 2008. Rev Bras Epidemiol Braz J Epidemiol. 2015;18:578–94. CrossRef
Correia Sacchi FP, Tatara MB, Camioli de Lima C, Ferreia da Silva L, Cunha EA, Simonsen V, et al. Genetic clustering of tuberculosis in an indigenous community of Brazil. Am J Trop Med Hyg. 2018;98(2):372–5.
Ministry of Health. Brazil Free of Tuberculosis: National Plan for the End of Tuberculosis as a Public Health Problem. Brasilia DF, Brazil. 2017. http://portalarquivos2.saude.gov.br/images/pdf/2017/julho/05/af-miolo-plano-nac-tuberculose-29jun17-grafica.pdf. Accessed 15 Feb 2018.
Cao K, Yang K, Wang C, Guo J, Tao L, Liu Q, et al. Spatial-temporal epidemiology of tuberculosis in mainland China: an analysis based on Bayesian theory. Int J Environ Res Public Health. 2016;13(5):E469.
GBD Tuberculosis Collaborators. The global burden of tuberculosis: results from the Global Burden of Disease Study 2015. Lancet Infect Dis. 2018;18(3):261–84.
GBD 2015 HIV Collaborators. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2015: the Global Burden of Disease Study 2015. Lancet HIV. 2016;3:e361–87. CrossRef
World Health Organization. International Statistical Classification of Diseases and Related Health Problems 10th Revision. 2016. http://www.who.int/classifications/icd/icdonlineversions/en/. Accessed 2 Feb 2018.
R Core Team. R: A Language and Environment for Statistical Computing. Vienna: Foundation for Statistical Computing; 2015.
Ministerio da Saude. Resident Population - Brazil. Ministerio da Saude. http://tabnet.datasus.gov.br/cgi/deftohtm.exe?ibge/cnv/popbr.def. Accessed 24 Apr 2017.
GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1345–422. CrossRefPubMedCentral
GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1151–210. CrossRef
MDC G, Carneiro M, de Abreu DMX, França EB. HIV/AIDS Mortality in Brazil, 2000–2015: Are there reasons for concern? Rev Bras Epidemiol Braz J Epidemiol. 2017;20(Suppl 01):182–90.
Federal Legislature of Brazil. Constitutional Amendment Number 95. http://legislacao.planalto.gov.br/legisla/legislacao.nsf/Viw_Identificacao/emc%2095-2016?OpenDocument. Accessed 25 May 2018.
Coburn BJ, Okano JT, Blower S. Using geospatial mapping to design HIV elimination strategies for sub-Saharan Africa. Sci Transl Med. 2017;9:383.
Queiroz BL, Freire FHM de A, Gonzaga MR, de Lima EEC. Completeness of death-count coverage and adult mortality (45q15) for Brazilian states from 1980 to 2010. Rev Bras Epidemiol Braz J Epidemiol. 2017;20(Suppl 01):21–33. CrossRef
França EB, Lansky S, MAS R, Malta DC, França JS, Teixeira R, et al. Leading causes of child mortality in Brazil, in 1990 and 2015: estimates from the Global Burden of Disease study. Rev Bras Epidemiol Braz J Epidemiol. 2017;20(Suppl 01):46–60. CrossRef
Fernandes FM de C, Martins E de S, Pedrosa DMAS, Evangelista M do SN. Relationship between climatic factors and air quality with tuberculosis in the Federal District, Brazil, 2003-2012. Braz J Infect Dis. 2017;21:369–75.
- Progress toward eliminating TB and HIV deaths in Brazil, 2001–2015: a spatial assessment
Jennifer M. Ross
Nathaniel J. Henry
Laura A. Dwyer-Lindgren
Andrea de Paula Lobo
Fatima Marinho de Souza
Molly H. Biehl
Sarah E. Ray
Robert C. Reiner Jr
Rebecca W. Stubbs
Kirsten E. Wiens
Michael J. Kutz
Natalia V. Bhattacharjee
Hmwe H. Kyu
Simon I. Hay
- BioMed Central
Neu im Fachgebiet Allgemeinmedizin
Meistgelesene Bücher aus dem Fachgebiet
Mail Icon II