Social determinants of pulmonary tuberculosis in Argentina.

BACKGROUND: In Argentina, approximately 9,000 new cases of tuberculosis (TB) are recorded every year, representing an incidence rate of 22 cases per 100,000 inhabitants. There are no reported studies in Argentina examining the factors that influence the unequal distribution of the disease. The aim of the study was to identify the relationship between the distribution of social and economic factors and TB in Argentina between 2008 and 2012. METHOD: An ecologic study involving 525 departmental jurisdictions was conducted. Simple linear regression analysis was performed, followed by multiple linear regression for each group of determinants. A final model of determinants of TB's incidence was constructed from a model of multiple linear regression. RESULTS: The following determinants explain 43% of the variability of TB's incidence rate among different jurisdictions: overcrowding, proportion of households with a sewage network, proportion of examined patients with respiratory symptoms and proportion of patients who discontinued treatment. DISCUSSION: This study makes an important contribution to a better understanding of the factors influencing the TB occurrence in Argentina, which is the result of a multidimensional and complex process. Thesefactors make part of this disease's social determination. CONCLUSION: TB incidence is associated with different determinants, from multiple levels. Inequalities in its distribution in Argentina are driven by the unequal distribution of key social determinants.

Social determinants of pulmonary tuberculosis in Argentina / Determinantes sociais da tuberculose pulmonar na Argentina

ABSTRACT: Background: In Argentina, approximately 9,000 new cases of tuberculosis (TB) are recorded every year, representing an incidence rate of 22 cases per 100,000 inhabitants. There are no reported studies in Argentina examining the factors that influence the unequal distribution of the disease. The aim of the study was to identify the relationship between the distribution of social and economic factors and TB in Argentina between 2008 and 2012. Method: An ecologic study involving 525 departmental jurisdictions was conducted. Simple linear regression analysis was performed, followed by multiple linear regression for each group of determinants. A final model of determinants of TB's incidence was constructed from a model of multiple linear regression. Results: The following determinants explain 43% of the variability of TB's incidence rate among different jurisdictions: overcrowding, proportion of households with a sewage network, proportion of examined patients with respiratory symptoms and proportion of patients who discontinued treatment. Discussion: This study makes an important contribution to a better understanding of the factors influencing the TB occurrence in Argentina, which is the result of a multidimensional and complex process. Thesefactors make part of this disease's social determination. Conclusion: TB incidence is associated with different determinants, from multiple levels. Inequalities in its distribution in Argentina are driven by the unequal distribution of key social determinants.

RESUMO: Introdução: Aproximadamente 9 mil novos casos de tuberculose (TB) por ano são registrados na Argentina, representando uma taxa de incidência de 22 casos por 100 mil habitantes. Não há estudos publicados que avaliaram os fatores que influenciam a distribuição desigual da doença na Argentina. O objetivo deste trabalho foi identificar a relação entre a distribuição dos fatores sociais e econômicos e da tuberculose na Argentina entre 2008 e 2012. Método: Foi realizado um estudo ecológico envolvendo 525 departamentos. Na análise procedeu-se uma regressão linear simples, seguida de regressão linear múltipla para cada grupo de determinantes. Um modelo final com os determinantes da incidência de TB foi construído por meio de regressão linear múltipla. Resultados: Os seguintes determinantes explicam 43% da variabilidade da taxa de incidência de TB entre diferentes jurisdições: aglomeração intradomiciliar, proporção de domicílios com rede de esgoto, proporção de pacientes examinados com sintomas respiratórios e proporção de pacientes com tratamento descontinuado. Discussão: Este estudo contribui de maneira importante para uma melhor compreensão dos fatores que influenciam a ocorrência da TB na Argentina, resultado de um processo multidimensional e complexo. Esses fatores fazem parte da determinação social dessa doença. Conclusão: A incidência de TB está associada a diferentes determinantes, de múltiplos níveis. A heterogeneidade na distribuição da tuberculose na Argentina deve-se, entre outros fatores, pela distribuição desigual de determinantes sociais e de acesso às ações de saúde.

Tendencias de la mortalidad por lesiones de tránsito en Argentina 2002-2015 / Trends in mortality due to traffic injuries in Argentina 2002-2015

INTRODUCCIÓN Según la Organización Mundial de la Salud, las lesiones por el tránsito ocupan los primeros lugares entre las causas de muerte y es la primera entre los jóvenes de 15 a 29 años. OBJETIVO Describir el perfil epidemiológico de las víctimas, evaluar la tendencia de la mortalidad por lesiones de tránsito (LT) y su asociación con el parque automotor y moto vehicular en Argentina entre 2002 y 2015. MÉTODOS Estudio ecológico con datos oficiales de mortalidad (codificados según CIE-10) y de parque automotor y moto vehicular para el período 2002-2015. La mortalidad por lesiones no intencionales inespecíficas fueron redistribuidas entre las no intencionales según la metodología de Global Burden of Disease. Se calcularon tasas brutas y ajustadas. Se realizaron modelos Poisson con efectos aleatorios para explorar asociaciones entre las variables en estudio. RESULTADOS Se estimó un aumento del número de muertes del 23% por el método de la redistribución. Se calculó para Argentina una tasa de mortalidad por lesiones de tránsito para el periodo de 13,78 por 100.000 habitantes. Las provincias con tasas más elevadas fueron Santiago del Estero, Santa Cruz y Jujuy con una tasa de 25,7; 25,4 y 24,9 por 100.000 habitantes respectivamente. La Ciudad Autónoma de Buenos Aires presentó la menor tasa, con media anual de 4,02 óbitos por 100.000 habitantes para el período 2002-2015. En relación al parque automotor y moto vehicular se observó un notable aumento en el período analizado. Al realizar los modelos de Poisson con efectos mixtos se observó que el riesgo fue mayor en los jóvenes varones motociclistas de Argentina, con un riesgo de 1,90% (IC 95% 1.81-1.98) para el país. DISCUSIÓN Se observaron grandes diferencias regionales, por tipo de usuario de la vía pública, por sexo y por edad, sustento para la implementación de políticas para revertir las tendencias actuales

Determinantes sociales de incidencia de tuberculosis pulmonar en la Republica Argentina / Social determinants of incidence of pulmonary tuberculosis in the Argentina Republic

Introducción: A pesar que la tuberculosis es una enfermedad prevenible y curable, continúa siendo un importante problema de salud pública en todo el mundo. En Argentina durante el año 2012 se registraron 9.070 casos de tuberculosis y la tasa de notificación fue de 22 casos por 100.000 habitantes. Son múltiples las razones que intervienen en la ocurrencia y transmisión de la enfermedad.Objetivos: Identificar los determinantes sociales de la tuberculosis pulmonar y sus distribuciones geográficas en la Argentina en el periodo 2008 - 2012. Metodología: Se llevó a cabo un estudio ecológico que incluyó 525 jurisdicciones departamentales de la República Argentina. Los datos se tomaron del registro de casos de tuberculosis pulmonar del Programa Nacional de Tuberculosis (PNCTB). Los indicadores socioeconómicos y la cartografía corresponden al Instituto Nacional de Estadísticas y Censos (INDEC) para el año 2010. El análisis estadístico de los datos se realizó en dos etapas. En primer lugar se realizó un análisis exploratorio de las variables y se obtuvieron mapas temáticos para cada una de ellas. En segundo lugar se evaluó la relación de la tasa de incidencia de tuberculosis con cada uno de los indicadores socioeconómicos por regresión lineal simple y posteriormente se los evaluó por grupo de variables a través de modelos de regresión lineal múltiple. Finalmente, se realizó un único modelo de regresión lineal múltiple en el cual se incluyeron todas las variables que resultaron significativas en los modelos de regresión por grupos de variables. Resultados: Los resultados del modelo final muestran que las variables de hacinamiento, proporción de hogares con sistema red cloacal, proporción de pacientes sintomáticos respiratorios examinados y proporción de pacientes que abandonaron el tratamiento, explican en un 43 por ciento la variabilidad de la tasa de incidencia de tuberculosis entre las distintas jurisdicciones departamentales de la Argentina...

Introduction: Although TB is a preventable and curable disease, remains a major public health problem worldwide. In Argentina during the year 2012, 9.070 TB case were recorded. The notification rate was 22 cases per 100,000 inhabitants. There are many reasons involved in the occurrence and transmission of the disease. Objectives: To identify the social determinants of pulmonary tuberculosis and their geographical distributions in Argentina in the period 2008-2012. Methodology: An ecological study involving 525 departmental jurisdictions of Argentina was conducted. The data were taken from the register of tuberculosis pulmonary cases at the National Tuberculosis Program (PNCTB). The socioeconomic indicators and charting correspond to the official institute of statistics and census from Argentina (INDEC) for 2010. The statistical analysis of the data was performed on two stages. First, an exploratory analysis of the variables was performed and thematic maps for each one were obtained. Secondly the ratio of the incidence rate of tuberculosis with each one through socioeconomic indicators through simple linear regression was evaluated. Subsequently, the groups of variables were evaluated by multiple linear regression models. Finally, it was performed a multiple linear regression model with all the significant variables for the regression models by groups of variables. Results: The results of the final model show that crowding, proportion of households with sewer, proportion of patients with respiratory symptoms examined and proportion of patients who discontinued treatment, explains the 43 percent the variability of the incidence rate tuberculosis among the different departmental jurisdictions of Argentina. Conclusions: There are social determinants associated with a higher incidence of tuberculosis. These results constitute a contribution to addressing the activities aimed at the prevention, diagnosis and tuberculosis control strategies...