Prevalence and patterns of multimorbidity among tuberculosis patients in Brazil: a cross-sectional study

International Journal for Equity in Health

Ethel L Maciel³  Lee W Riley¹  Bernardo L Horta²  Laylla R Macedo³  Teresa Gomes³  Bárbara Reis-Santos² 

[1] Division of Infectious Disease and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA;Post-Graduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil;Lab-Epi UFES Laboratory of Epidemioly of Universidade Federal do Espírito Santo, Av. Marechal Campos 1468 – Maruípe, Vitória, ES, Brazil

关键词: Hierarchical models;    Social determinants;    Inequity;    Multimorbidities;    Tuberculosis;   

Others  :  811646
DOI  :  10.1186/1475-9276-12-61

 received in 2012-12-23, accepted in 2013-06-24,  发布年份 2013

【 摘 要 】

Introduction

The number of subjects with tuberculosis (TB) presenting with co-occurrence of multiple chronic medical conditions, or multimorbidity (MM) is increasing in Brazil. This manuscript aimed to characterize subjects with TB, according to their MM status and to analyse factors associated with TB treatment outcomes.

Methods

This is a cross-sectional study that included 39,881 TB subjects reported in Brazil, in 2011. MM were defined as any (two or more) occurrence of chronic medical conditions in a TB patient (TB–MM). Data analysis was performed by hierarchical logistic regression models comparing TBMM with those with only TB.

Results

Of the reported TB cases in 2011, 454 (1.14%) had MM. The subjects in the age group 40–59 years (OR: 17.89; 95% CI, 5.71-56.03) and those ≥ 60 years (OR: 44.11; 95% CI, 14.09-138.06) were more likely to develop TB–MM. The TB–MM subjects were less likely to be male (OR: 0.63; 95% CI, 0.52-0.76), institutionalized (OR: 0.59; 95% CI, 0.23-0.80) and live in rural areas (OR: 0.63; 95% CI, 0.42-0.95). Death from causes other than TB was higher among TB–MM subjects (OR: 1.76; 95% CI, 1.36-2.28). Of 454 TB–MM subjects 302 (66.5%) were cured and 152 (33.5%) were not cured. The odds of not being cured was 1.55 (95% CI, 1.04-2.32) among males, 2.85 (95% CI, 1.12-7.28) among institutionalized subjects, and 3.93 (IC 95%, 1.86-8.30) among those who were infected with HIV. TB retreatment after previous abandonment (OR: 7.53; 95% CI, 2.58-21.97) and transfer from a treatment site (OR: 2.76; 95% CI, 1.20-6.38) were higher for subjects not cured compared to those who were cured.

Conclusions

While TB is well recognized to be a disease engendered by social inequity, we found that even among TB patients, those who have MM have greater inequity in terms of socioeconomic status and adverse clinical outcomes. Addressing the problem of TB and TB–MM requires a multisectorial approach that includes health and social service organizations.

【 授权许可】

   
2013 Reis-Santos et al.; licensee BioMed Central Ltd.

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