Environmental and social effects on the incidence of tuberculosis in three Brazilian municipalities and in Federal District

Abstract

Introduction: The territorial characteristics, heterogeneities of landscapes, and the regional profiles of Brazil show great disparities in the spatial distribution of tuberculosis burden. Objective of this study is to analyze the effects of environmental and social factors on tuberculosis incidence in three Brazilian municipalities and in the Federal District of Brazil. Methodology: We performed an ecological study carried out with 131,576 new cases of tuberculosis registered in the Brazilian national disease notification system. For our research we used climatic data, topographic data and socioeconomic data. Results: Wind speed and vapor pressure increased the risk of tuberculosis infection between 4.6 and 5.8 times in the 3 municipalities, in comparison with the Federal District. In Recife socioeconomic aspects showed a greater association with tuberculosis. Lack of garbage collection, poor basic sanitation, and access to drinking water, respectively, increased 49, 33, and 28 times the risk of infection. In the multiple regression analysis, Rio de Janeiro showed several environmental characteristics – such as precipitation (p = 0.002), radiation (p = 0.020) and water vapor (p = 0.055) – and social characteristics associated with tuberculosis – such as the lack of sewage treatment, which revealed a 13.5-fold higher risk of infection (p < 0.001). Conclusions: Incidence in the areas studied was influenced by environmental and social conditions at different levels depending on the territory where the problem was identified. The results make it possible to guide an urban and social policy to reach the targets set out in the WHO End tuberculosis Strategy in large Brazilian urban agglomerations.