IHMT

Instituto de Higiene e Medicina Tropical

Home / Publicações / Tuberculosis and social inequity in health: an ecological study using multivariate statistical techniques, São Paulo, Brazil

Tuberculosis and social inequity in health: an ecological study using multivariate statistical techniques, São Paulo, Brazil

Objective

To identify the patterns of São Paulo state municipalities, in Brazil, regarding the relationship between tuberculosis and indicators of health care services, health care service availability, context, and social inequality.

Methods

This ecological study covered all 645 municipalities of São Paulo and eight variables belonging to three dimensions: health care service availability, context, and social inequality. Data were analyzed using hierarchical and non-hierarchical clustering, principal components analysis, and geoprocessing.

Results

The analysis revealed five groups of municipalities: group 1 (117 municipalities), with similar directly observed treatment (DOT) and family health strategy (FHS) coverage, high tuberculosis incidence and death coefficients, and a low human development index (HDI); group 2 (142 municipalities), with low DOT and FHS coverage; group 3 (36 municipalities), with medium DOT and FHS coverage and high tuberculosis incidence, high demand for anti-HIV testing, and treatment dropout; group 4 (186 municipalities) with lower HDI as compared to groups 2, 3, and 5, but high FHS coverage and the lowest numbers of anti-HIV testing, tuberculosis incidence, and DOT coverage; and group 5 (164 municipalities), with better social conditions as compared to the other groups, medium FHS coverage, and higher DOT coverage. Together, the first two components selected for the study-health service availability in terms of DOT coverage indicator and social inequality indicator-explained 76.96% of the variance. In municipalities with high DOT coverage there was evidence of better organized tuberculosis control services.

Conclusions

Municipalities with the highest social inequality had FHS coverage. However, without DOT, FHS seem less efficient to control tuberculosis.

Tuberculosis and social inequity in health: an ecological study using multivariate statistical techniques, São Paulo, Brazil

Objective

To identify the patterns of São Paulo state municipalities, in Brazil, regarding the relationship between tuberculosis and indicators of health care services, health care service availability, context, and social inequality.

Methods

This ecological study covered all 645 municipalities of São Paulo and eight variables belonging to three dimensions: health care service availability, context, and social inequality. Data were analyzed using hierarchical and non-hierarchical clustering, principal components analysis, and geoprocessing.

Results

The analysis revealed five groups of municipalities: group 1 (117 municipalities), with similar directly observed treatment (DOT) and family health strategy (FHS) coverage, high tuberculosis incidence and death coefficients, and a low human development index (HDI); group 2 (142 municipalities), with low DOT and FHS coverage; group 3 (36 municipalities), with medium DOT and FHS coverage and high tuberculosis incidence, high demand for anti-HIV testing, and treatment dropout; group 4 (186 municipalities) with lower HDI as compared to groups 2, 3, and 5, but high FHS coverage and the lowest numbers of anti-HIV testing, tuberculosis incidence, and DOT coverage; and group 5 (164 municipalities), with better social conditions as compared to the other groups, medium FHS coverage, and higher DOT coverage. Together, the first two components selected for the study-health service availability in terms of DOT coverage indicator and social inequality indicator-explained 76.96% of the variance. In municipalities with high DOT coverage there was evidence of better organized tuberculosis control services.

Conclusions

Municipalities with the highest social inequality had FHS coverage. However, without DOT, FHS seem less efficient to control tuberculosis.