Progress toward eliminating TB and HIV deaths in Brazil, 2001-2015: A spatial assessment
<h4>Background</h4> <p>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 modellin...
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
BioMed Central
2018
|
| _version_ | 1797085582451539968 |
|---|---|
| author | Ross, JM Henry, NJ Dwyer-Lindgren, LA De Paula Lobo, A De Souza, F Biehl, MH Ray, SE Reiner, RC Stubbs, RW Wiens, KE Earl, L Kutz, MJ Bhattacharjee, NV Kyu, HH Naghavi, M Hay, SI |
| author_facet | Ross, JM Henry, NJ Dwyer-Lindgren, LA De Paula Lobo, A De Souza, F Biehl, MH Ray, SE Reiner, RC Stubbs, RW Wiens, KE Earl, L Kutz, MJ Bhattacharjee, NV Kyu, HH Naghavi, M Hay, SI |
| author_sort | Ross, JM |
| collection | OXFORD |
| description | <h4>Background</h4> <p>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.</p> <h4>Methods</h4> <p>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.</p> <h4>Results</h4> <p>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.</p> <h4>Conclusions</h4> <p>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.</p> |
| first_indexed | 2024-03-07T02:10:45Z |
| format | Journal article |
| id | oxford-uuid:a08c16de-21a5-4177-9253-00a4f136c76b |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T02:10:45Z |
| publishDate | 2018 |
| publisher | BioMed Central |
| record_format | dspace |
| spelling | oxford-uuid:a08c16de-21a5-4177-9253-00a4f136c76b2022-03-27T02:06:23ZProgress toward eliminating TB and HIV deaths in Brazil, 2001-2015: A spatial assessmentJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:a08c16de-21a5-4177-9253-00a4f136c76bEnglishSymplectic Elements at OxfordBioMed Central2018Ross, JMHenry, NJDwyer-Lindgren, LADe Paula Lobo, ADe Souza, FBiehl, MHRay, SEReiner, RCStubbs, RWWiens, KEEarl, LKutz, MJBhattacharjee, NVKyu, HHNaghavi, MHay, SI <h4>Background</h4> <p>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.</p> <h4>Methods</h4> <p>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.</p> <h4>Results</h4> <p>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.</p> <h4>Conclusions</h4> <p>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.</p> |
| spellingShingle | Ross, JM Henry, NJ Dwyer-Lindgren, LA De Paula Lobo, A De Souza, F Biehl, MH Ray, SE Reiner, RC Stubbs, RW Wiens, KE Earl, L Kutz, MJ Bhattacharjee, NV Kyu, HH Naghavi, M Hay, SI Progress toward eliminating TB and HIV deaths in Brazil, 2001-2015: A spatial assessment |
| title | Progress toward eliminating TB and HIV deaths in Brazil, 2001-2015: A spatial assessment |
| title_full | Progress toward eliminating TB and HIV deaths in Brazil, 2001-2015: A spatial assessment |
| title_fullStr | Progress toward eliminating TB and HIV deaths in Brazil, 2001-2015: A spatial assessment |
| title_full_unstemmed | Progress toward eliminating TB and HIV deaths in Brazil, 2001-2015: A spatial assessment |
| title_short | Progress toward eliminating TB and HIV deaths in Brazil, 2001-2015: A spatial assessment |
| title_sort | progress toward eliminating tb and hiv deaths in brazil 2001 2015 a spatial assessment |
| work_keys_str_mv | AT rossjm progresstowardeliminatingtbandhivdeathsinbrazil20012015aspatialassessment AT henrynj progresstowardeliminatingtbandhivdeathsinbrazil20012015aspatialassessment AT dwyerlindgrenla progresstowardeliminatingtbandhivdeathsinbrazil20012015aspatialassessment AT depaulaloboa progresstowardeliminatingtbandhivdeathsinbrazil20012015aspatialassessment AT desouzaf progresstowardeliminatingtbandhivdeathsinbrazil20012015aspatialassessment AT biehlmh progresstowardeliminatingtbandhivdeathsinbrazil20012015aspatialassessment AT rayse progresstowardeliminatingtbandhivdeathsinbrazil20012015aspatialassessment AT reinerrc progresstowardeliminatingtbandhivdeathsinbrazil20012015aspatialassessment AT stubbsrw progresstowardeliminatingtbandhivdeathsinbrazil20012015aspatialassessment AT wienske progresstowardeliminatingtbandhivdeathsinbrazil20012015aspatialassessment AT earll progresstowardeliminatingtbandhivdeathsinbrazil20012015aspatialassessment AT kutzmj progresstowardeliminatingtbandhivdeathsinbrazil20012015aspatialassessment AT bhattacharjeenv progresstowardeliminatingtbandhivdeathsinbrazil20012015aspatialassessment AT kyuhh progresstowardeliminatingtbandhivdeathsinbrazil20012015aspatialassessment AT naghavim progresstowardeliminatingtbandhivdeathsinbrazil20012015aspatialassessment AT haysi progresstowardeliminatingtbandhivdeathsinbrazil20012015aspatialassessment |