Risk-prone territories for spreading tuberculosis, temporal trends and their determinants in a high burden city from São Paulo State, Brazil.

OBJECTIVES: To identify risk-prone areas for the spread of tuberculosis, analyze spatial variation and temporal trends of the disease in these areas and identify their determinants in a high burden city. METHODS: An ecological study was carried out in Ribeirão Preto, São Paulo, Brazil. The population was composed of pulmonary tuberculosis cases reported in the Tuberculosis Patient Control System between 2006 and 2017. Seasonal Trend Decomposition using the Loess decomposition method was used. Spatial and spatiotemporal scanning statistics were applied to identify risk areas. Spatial Variation in Temporal Trends (SVTT) was used to detect risk-prone territories with changes in the temporal trend. Finally, Pearson's Chi-square test was performed to identify factors associated with the epidemiological situation in the municipality. RESULTS: Between 2006 and 2017, 1760 cases of pulmonary tuberculosis were reported in the municipality. With spatial scanning, four groups of clusters were identified with relative risks (RR) from 0.19 to 0.52, 1.73, 2.07, and 2.68 to 2.72. With the space-time scan, four clusters were also identified with RR of 0.13 (2008-2013), 1.94 (2010-2015), 2.34 (2006 to 2011), and 2.84 (2014-2017). With the SVTT, a cluster was identified with RR 0.11, an internal time trend of growth (+ 0.09%/year), and an external time trend of decrease (- 0.06%/year). Finally, three risk factors and three protective factors that are associated with the epidemiological situation in the municipality were identified, being: race/brown color (OR: 1.26), without education (OR: 1.71), retired (OR: 1.35), 15 years or more of study (OR: 0.73), not having HIV (OR: 0.55) and not having diabetes (OR: 0.35). CONCLUSION: The importance of using spatial analysis tools in identifying areas that should be prioritized for TB control is highlighted, and greater attention is necessary for individuals who fit the profile indicated as "at risk" for the disease.

Tuberculosis forecasting and temporal trends by sex and age in a high endemic city in northeastern Brazil: where were we before the Covid-19 pandemic?

BACKGROUND: The aim of this study was to describe the temporal trend of tuberculosis cases according to sex and age group and evidence the level of disease before the Covid-19 pandemic in a TB high endemic city. METHODS: This was a time series study carried out in a city in northeast Brazil. The population was composed of cases of tuberculosis, excluding those with HIV-positive status, reported between the years 2002 and 2018. An exploratory analysis of the monthly rates of tuberculosis detection, smoothed according to sex and age group, was performed. Subsequently, the progression of the trend and prediction of the disease were also characterized according to these aspects. For the trends forecast, the seasonal autoregressive linear integrated moving average (ARIMA) model and the usual Box-Jenkins method were used to choose the most appropriate models. RESULTS: A total of 1620 cases of tuberculosis were reported, with an incidence of 49.7 cases per 100,000 inhabitants in men and 34.0 per 100,000 in women. Regarding the incidence for both sexes, there was a decreasing trend, which was similar for age. Evidence resulting from the application of the time series shows a decreasing trend in the years 2002-2018, with a trend of stability. CONCLUSIONS: The study evidenced a decreasing trend in tuberculosis, even before the Covid-19 pandemic, for both sex and age; however, in a step really slow from that recommended by the World Health Organization. According to the results, the disease would have achieved a level of stability in the city next years, however it might have been aggravated by the pandemic. These findings are relevant to evidence the serious behavior and trends of TB in a high endemic scenario considering a context prior to the Covid-19 pandemic.

Causes of multidrug-resistant tuberculosis from the perspectives of health providers: challenges and strategies for adherence to treatment during the COVID-19 pandemic in Brazil.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is a serious phenomenon on a global scale that can worsen with the COVID-19 pandemic. The study aimed to understand the perceptions of health professionals about MDR-TB, their strategies to ensure adherence to treatment and their challenges in the context of the COVID-19 pandemic in a priority municipality for disease control. METHODS: We conducted a qualitative study and recruited 14 health providers (four doctors, three nurses, three nursing technicians, three nursing assistants and a social worker) working in a city in the state of São Paulo, Brazil. Remote semi-structured interviews were conducted with the participants. For data analysis, the thematic content analysis technique was applied according to the study's theoretical framework. RESULTS: The study revealed the causes of MDR-TB are associated with poverty, vulnerability, and social risk. A pre-judgement from the providers was observed, namely, all patients do not adhere due their resistance and association with drug abuse or alcoholism. The study also observed difficulty among health providers in helping patients reconstruct and reframe their life projects under a care perspective, which would strengthen adherence. Other issues that weakened adherence were the cuts in social protection and the benefits really necessary to the patients and a challenge for the providers manage that. The participants revealed that their actions were impacted by the pandemic and insecurity and fear manifested by patients after acquiring COVID-19. For alleviating this, medical appointments by telephone, delivery of medicine in the homes of patients and visits by health professionals once per week were provided. CONCLUSION: The study advances knowledge by highlighting the challenges faced by the health system with the adherence of patients with MDR-TB in a context aggravated by the pandemic. An improvement in DOT is really necessary to help the patients reframe their lives without prejudices, face their fears and insecurity, recover their self-esteem and motivate in concluding their treatment.

Assessment instruments and depression rates in people with spinal cord injury: a systematic review.

OBJECTIVE: To identify, describe, differentiate and qualify the instruments used to evaluate depression and also identify the percentage and average rates of depression in people with spinal cord injury. METHOD: This is a systematic review of the literature implementing a qualitative approach. SciELO, LILACS, PubMed and PsycINFO databases were consulted. Original articles were classified according to the variables (Spinal Cord Injury, Depression and Assessment instruments). The studies are presented according to the instruments in recent publications in the past 11 years. RESULTS: Five evaluation instruments were found. PHQ-9, a screening instrument for diagnosing depression was used in most studies, with all being performed in the United States and having a higher impact factor and number of participants. Studies with PHQ-9 presented a total score of people who met the criteria for depression without grading by severity with an average of 17.6% ± 7.3%, while BDI presented 51.6% ± 15.1% and the HADS showed 37.5% ± 31% of people with some degree of depression. CONCLUSION: This study was important in identifying which instruments can be used to assess depression, the description of each, some of their differences, which ones are used in the best studies and o the depression rates in different parts of the world. It was also important to show how the PHQ-9 is an important instrument, but is limited to being used in the USA.

Social ruptures and the everyday life of homeless people: an ethnographic study. / As rupturas sociais e o cotidiano de pessoas em situação de rua: estudo etnográfico.

OBJECTIVE: To discover the generators of disruptions in social support networks and identify the everyday life and projects of life of homeless people. METHOD: Ethnographic study conducted between 2012 and 2013 in Ribeirão Preto -SP, Brazil. The participants were fifteen homeless people. Data were collected through video-recorded interviews addressing histories of life and a field diary. Data analysis was based on Habermas' Theory of Communicative Action. RESULTS: Results revealed that the participants' families have faced inequalities for many generations and that everyday life is marked by violence and death, poverty and exclusion, disrupted social networks, loneliness, alcohol and drug consumption, and other socially determined diseases. CONCLUSION: The situation of living on the streets stems from several factors present in the organization of the Brazilian society and social determinants condition the life and health of homeless people.

Social protection in areas vulnerable to tuberculosis: a mixed methods study in São Luís, Maranhão.

OBJECTIVES: to analyze the risk areas for tuberculosis and the influences of social protection on the development of treatment for the disease in the municipality of São Luís, Maranhão. METHODS: this is explanatory sequential mixed method research. In the quantitative phase, the data were obtained from the Notifiable Diseases Information System from 2010 to 2019, with georeferencing being carried out to identify areas vulnerable to tuberculosis. In the qualitative phase, semi-structured interviews were carried out with individuals who received social benefits. RESULTS: 7,381 cases were geocoded, and, from the purely spatial scanning analysis, it was possible to identify 13 spatial clusters of risk. As for the interviews, there was a positive relationship between patient improvement and receiving benefits. CONCLUSIONS: geographic space and social determinants are relevant for reorienting monitoring actions for the conditions that generate the health-disease process.

Psychosocial impacts of the COVID-19 pandemic among settled women: A longitudinal study.

OBJECTIVE: to analyze the psychosocial impacts of the COVID-19 pandemic among Brazilian women from rural settlements. METHOD: this is a quantitative and longitudinal study conducted with 13 settled women. The data were collected between January 2020 and September 2021 using questionnaires on the perception of the social environment (quality of life, social support, self-efficacy), common mental disorder symptoms and sociodemographic aspects. The data were analyzed using descriptive statistics, cluster analysis and variance analysis. RESULTS: intersecting vulnerability conditions were identified that possibly intensified the challenges arising from the pandemic. The Quality of Life physical domain fluctuated differently and inversely according to the mental disorder symptoms. As for the psychological domain, at the end of the segment, an increase over time was identified in the entire sample, as the women's perception was better than before the pandemic. CONCLUSION: worsening of the participants' physical health deserves to be highlighted and, probably, it can be related to the difficulty accessing health services in this period as well as to the fear of contamination. Despite this, the participants were emotionally resilient throughout the period, including signs of improvement in terms of psychological aspects, suggesting a possible effect of the community organization of the settlement.

Expansion of Psychosocial Care Centers and their relationship with health and human rights.

OBJECTIVE: To analyze the factors associated with the expansion of the number of Brazilian Psychosocial Care Centers (CAPS) considering aspects related to the general health scenario and the institutionalization of human rights. METHODS: An analytical document-based study, developed between February 2020 and May 2022, whose secondary data on the 27 Brazilian capitals were collected on platforms in the public domain, based on the time series from 2015 to 2020. Indicators were listed based on health system infrastructure and quality of life. For data analysis, descriptive statistics, Pearson's correlation test and Student's t test were used. RESULTS: The capitals that expanded the number of CAPS in the analyzed period were the ones that presented the greatest political-legal framework for the protection of human rights. CONCLUSION: The results suggest that the greater the commitment of governments in favor of human rights, the greater the investment for CAPS expansion.

Factors associated with status and self-perceived mental health changes in the face of the COVID-19 pandemic in Brazil.

The SARS-CoV-2-triggered Public Health Emergency of International Importance has significantly contributed to emotional and mental health issues. The aim of this study was to identify factors associated with self-perceived mental health changes while facing the COVID-19 pandemic in Brazil. This was a cross-sectional, descriptive, and analytical study that collected data via a web survey using a validated instrument. The study included individuals over 18 years old residing in the 26 federal units and the Federal District from August 2020 to November 2022. The sample was recruited using the snowball technique. Two logistic regression analyses were conducted to identify factors associated with the outcomes of interest. The first analysis considered individuals who rated their mental health condition as poor as the dependent variable, while the second analysis considered individuals who reported changes in their mental health during the pandemic as the dependent variable. The study found that individuals with complete college education and those using tranquilizers or antidepressants were more likely to perceive their mental health as poor (1.97 and 2.04 times higher likelihood, respectively). Increased consumption of ultra-processed foods during the pandemic was associated with a 2.49 higher likelihood of reporting mental health changes. Participants also reported more difficulty sleeping. The negative self-perception of mental health varied across Brazil's regions and changed over time, with different patterns observed before and after the vaccination period. In 2022, most regions of Brazil classified their mental health as "poor." The study highlights the impact of the COVID-19 pandemic on mental health, with increased prevalence of mental disorders and emotional problems among the population. The results highlight the presence of mental disorders and increased reporting of emotional problems among the population due to the impact of the COVID-19 pandemic.

Autonomy of people with psychological suffering from the perspective of work: Perceptions of users and their families.

OBJECTIVE: To present the results of a study with a psychosocial approach that aimed to examine the autonomy of people with mental suffering cared for at psychosocial care centres from the perspective of work, based on the perceptions of the users and their families, and using the psychosocial rehabilitation framework and Agnes Heller's theory of everyday life. METHODS: Four psychosocial care centres were selected, and 40 people collaborated with the research through semi-structured interviews analysed with the Collective Subject Discourse technique. RESULTS: Although the users wanted to have a job, they showed no initiative, as there are impediments to carrying out work activities due to the side effects of the medication and the obstacles posed by third parties concerned about the loss of social benefits. Prejudice was seen as a mechanism that negatively interferes with social relations and empowerment for autonomy. Expectations of resuming studies and participation in voluntary activities, especially religious ones, were frequent in the users' discourse. CONCLUSIONS: There is an urgent need to expand territorial spaces so that the users of mental health services can be protagonists of their own autonomy and carry out their occupations in the area of productivity with greater ownership.

Social determinants of health and unfavourable outcome of tuberculosis treatment in the prison system. / Determinantes sociais da saúde e desfecho desfavorável do tratamento da tuberculose no sistema prisional.

This article aims to analyze the unfavorable outcome of tuberculosis treatment among the population deprived of liberty by social determinants of health. This retrospective cohort was conducted in the states of Rondônia and São Paulo, Brazil, with inmates with tuberculosis notified between 2008 and 2017. Data were collected from SINAN and TB-WEB and analyzed by relative risk (RR) and confidence intervals (95%CI), which tested the association between the dependent variable (unfavorable outcome (deaths from tuberculosis and other causes, and primary and non-primary lost to follow-up) vs. favorable outcome (cure)) and the structural and intermediary determinants of health. One hundred fifty-eight unfavorable outcomes were registered in Rondônia and 2,227 in São Paulo. For Rondônia, this outcome was associated with gender (RR 3.09; 95%CI 1.03-9.27) and AIDS (RR 2.46; 95%CI 1.63-3.71). In São Paulo, aged over 30 years (RR 1.36; 95%CI 1.26-1.47), AIDS (RR 3.08; 95%CI 2.81-3.38), alcohol abuse (RR 1.54; 95%CI 1.35-1.76), diabetes (RR 1.70; 95%CI 1.27-2.28) and self-administered treatment (RR 2.55; 95%CI 2.27-2.86) were risk factors for the unfavorable outcome. The study contributes with elements to the risk stratification of people with tuberculosis in prison units and, thus, improves health care towards a favorable outcome.

O objetivo deste artigo é analisar o desfecho desfavorável do tratamento da tuberculose entre a população privada de liberdade segundo os determinantes sociais de saúde. Coorte retrospectiva realizada nos estados de Rondônia e São Paulo, Brasil, com detentos com tuberculose notificados entre 2008 e 2017. Os dados foram coletados do SINAN e do TB-WEB e analisados pelo risco relativo (RR), com intervalos de confiança (IC95%), testando a associação entre a variável dependente [desfecho desfavorável (óbitos por tuberculose e outras causas, assim como os abandonos, primários ou não) x favorável (cura)] e os determinantes estruturais e intermediários da saúde. Foram registrados 158 desfechos desfavoráveis em Rondônia e 2.227 em São Paulo. Para Rondônia, tal desfecho esteve associado a sexo masculino (RR 3,09; IC95% 1,03-9,27) e Aids (RR 2,46; IC95% 1,63-3,71). Em São Paulo, idade superior a 30 anos (RR 1,36; IC95% 1,26-1,47), Aids (RR 3,08; IC95% 2,81-3,38), alcoolismo (RR 1,54; IC95% 1,35-1,76), diabetes (RR 1,70; IC95% 1,27-2,28) e tratamento autoadministrado (RR 2,55; IC95% 2,27-2,86) constituíram fatores de risco para o desfecho desfavorável. O estudo contribui com elementos para a estratificação de risco das pessoas com tuberculose nas unidades de saúde prisionais, fornecendo subsídios para qualificar a assistência para o desfecho favorável dos casos.

Autonomy of People with Psychological Suffering from the Perspective of Work: Perceptions of Users and their Families. / Autonomía de las personas con sufrimiento psíquico desde la perspectiva del trabajo: percepciones de los usuarios y sus familias.

OBJECTIVE: To present the results of a study with a psychosocial approach that aimed to examine the autonomy of people with mental suffering cared for at psychosocial care centres from the perspective of work, based on the perceptions of the users and their families, and using the psychosocial rehabilitation framework and Agnes Heller's theory of everyday life. METHODS: Four psychosocial care centres were selected, and 40 people collaborated with the research through semi-structured interviews analysed with the Collective Subject Discourse technique. RESULTS: Although the users wanted to have a job, they showed no initiative, as there are impediments to carrying out work activities due to the side effects of the medication and the obstacles posed by third parties concerned about the loss of social benefits. Prejudice was seen as a mechanism that negatively interferes with social relations and empowerment for autonomy. Expectations of resuming studies and participation in voluntary activities, especially religious ones, were frequent in the users' discourse. CONCLUSIONS: There is an urgent need to expand territorial spaces so that the users of mental health services can be protagonists of their own autonomy and carry out their occupations in the area of productivity with greater ownership.

Depression or anxiety symptoms associated with occupational role transitions in Brazilian adults with a traumatic spinal cord injury: A multivariate analysis.

BACKGROUND: Psychological morbidity is commonly experienced by people with a spinal cord injury (SCI), but whether it is associated with occupational role transitions in is unknown. OBJECTIVE: To analyze whether anxiety or depression symptoms are independently associated to increased likelihoods of role transitions in adults with SCI. METHODS: Cross-sectional study; multivariate analysis using a heteroscedastic Dirichlet regression. PARTICIPANTS: Thirty persons with traumatic SCI. MEASURES: Role Checklist (e.g. role transitions: dependent variables) and Beck's Depression Inventory and State-Trait Anxiety Inventory (independent variables), adjusted for socio-demographic, functional, and injury-level confounders. RESULTS: Greater depression symptoms independently increased the likelihood of occupational role transitions, either for roles loss [adjusted Odds Ratio (AOR): 1.04; 95% confidence interval (CI):1.009-1.080] or roles gain [AOR: 1.07; 95% CI:1.02-1.13], as opposed to continued occupational roles. Higher anxiety as a trait, in turn, independently reduced the likelihood of occupational roles gain [AOR: 0.93; 95% CI: 0.869-0.992]. The "worker" role was the one lost more frequently (83%). CONCLUSION: Psychological morbidity is associated to occupational role transitions, as opposed to continued roles. Further research (e.g. with larger samples, longitudinal design, using structural equation modelling) should elucidate on the intricate relationships between mental health status and occupational role transitions in people experiencing SCI.

Intersectoral actions in decreasing social inequities faced by children and adolescents.

OBJECTIVE: to identify the evidence about the repercussion of intersectoral programs / actions / strategies in the reduction of social inequities experienced by children and adolescents in social vulnerability. METHOD: integrative review performed in the following databases: National Library of Medicine, Cumulative Index to Nursing and Allied Health Literature, Latin-American and Caribbean Health Sciences Literature, Web of Science, Scopus, and Scientific Electronic Library Online. Primary studies published between 2005 and 2019, written in English, Portuguese, or Spanish, were included. The Rayyan tool was used during selection. The sample was composed of 27 studies, and Ursi was used to extract data. The studies' methodological quality was verified with the Mixed Methods Appraisal Tool, and descriptive statistics were used. RESULTS: the main results show that intersectoral actions resulted in improved access to health, improved child nutrition indicators, better mental health care, the adoption of a healthy lifestyle, and improved quality of life. CONCLUSION: significant advancements found in the development and lives of children and adolescents are assigned to intersectoral actions. The studies report that different strategies were used in different regions worldwide and contributed to improved children's and adolescents' quality of life, supporting new intersectoral policies.

Impact of social protection programs on adults diagnosed with Tuberculosis: systematic review.

OBJECTIVES: to analyze the impact of social protection programs on adults diagnosed with Tuberculosis. METHODS: systematic review conducted by PRISMA, with registration PROSPERO CRD42019130884. The studies were identified in the VHL, PubMed, Scielo, CINAHL and Scopus databases, using the descriptors "Social Protection" and "Tuberculosis", in combination with keywords combined with Boolean operators AND and OR. Observational and interventional studies published until October 23, 2019, in Portuguese, English and Spanish, were included. RESULTS: social protection programs improve the treatment of tuberculosis, cure rates, adherence to treatment, the provision of services for the control of TB and reduce poverty. CONCLUSIONS: social protection programs have a positive impact on the treatment and control of people diagnosed with Tuberculosis.

The influence of work environment relationships on mental health of Brazilian seamstresses.

BACKGROUND: The work environment is a place in which different kinds of interpersonal relationships are developed and can contribute positively or negatively to productivity and to workers' well-being. Discussion on this topic may contribute to building more coping strategies to fight against gender inequality and the emotional repercussions of these conditions. OBJECTIVE: This is a cross-sectional study that investigated the possible influence of work environment relationships on the mental health of Brazilian seamstresses. METHODS: The participants were seamstresses from four clothing factories in a city in the southwest of Brazil. For data collection, we used the Social Support Perception at Work Scale; Self-Report Questionnaire; Alcohol, Smoking and Substance Involvement Screening Test; and a focus group. The quantitative data were statistically analyzed, and data from the focus groups were analyzed using content analysis. RESULTS: Interpersonal relationships at work were mentioned as sources of conflict and stress but also as emotional and material social support providers. In the sample studied, these relationships did not influence directly the development of mental health disorders. CONCLUSIONS: Study results suggest that a low level of education is an important factor that increases the vulnerability of these women to the precariousness of work, and, consequently to developing mental health symptoms or aggravating previous mental health distress. However, emotional and material support from peers likely protects these workers' mental health.

Temporal trend of tuberculosis incidence and its spatial distribution in Macapá - Amapá.

OBJECTIVE: To evaluate the temporal trend of tuberculosis incidence after the implementation of the rapid molecular test (RMT-TB), to identify whether tuberculosis presents seasonal variation and to classify the territory according to case density and risk areas in Macapá, Amapá. METHODS: Ecological study of tuberculosis cases registered in the Sistema de Informação de Agravos de Notificação (SINAN - Information System for Notifiable Diseases) between 2001 and 2017. We used the Prais-Winsten test to classify the temporal trend of incidence and the interrupted time series to identify changes in the temporal trend before and after the implementation of the rapid molecular test, and to verify seasonality in the municipality. The Kernel estimator was used to classify case density and scan statistics to identify areas of tuberculosis risk. RESULTS: A total of 1,730 cases were identified, with a decreasing temporal trend of tuberculosis incidence (-0.27% per month, 95%CI -0.13 to -0.41). The time series showed no change in level after the implementation of the GeneXpert®MTB/RIF molecular test; however, the incidence increased in the post-test period (+2.09% per month, 95%CI 0.92 to 3.27). Regarding the seasonal variation, it showed growth (+13.7%/month, 95%CI 4.71 to 23.87) from December to June, the rainy season - called amazon winter season -, and decrease (-9.21% per month, CI95% -1.37 to -16.63) in the other periods. We classified areas with high density of cases in the Central and Northern districts using Kernel and identified three protection clusters, SC1 (RR = 0.07), SC2 (RR = 0.23) and SC3 (RR = 0.36), and a high-risk cluster, SC4 (RR = 1.47), with the scan statistics. CONCLUSION: The temporal trend of tuberculosis incidence was decreasing in the time series; however, detection increased after the introduction of RMT-TB, and tuberculosis showed seasonal behavior. The case distribution was heterogeneous, with a tendency to concentrate in vulnerable and risk territories, evidencing a pattern of disease inequality in the territory.

Social iniquities in Primary Healthcare and intersectoral action: a descriptive study.

OBJECTIVE: To analyze Primary Healthcare with regards to dealing with social inequities through actions targeted at Social Determinants of Health, from the perspective of Family Health Strategy Professionals. METHODS: Descriptive study with a qualitative approach. Data were collected through focus groups and analyzed using Habermas's communicative action theory. RESULTS: There were few intersectoral and assistance organization actions with clinical emphasis; municipal management for intersectoral actions shows a lack of planning and faces challenges; and there is little communication and articulation between the sectors. Final considerations: There are many challenges to be overcome by Primary Health Care to contemplate intersectoral actions targeted at Social Health Determinants, a demand inherent to the possibilities of advancing in the reduction of social and health-related inequalities.

Therapeutic follow-up and network intervention as a strategy in psychosocial care.

OBJECTIVE: to analyze Therapeutic Follow-Up (TF) and Network Intervention (NI) as devices for social network/Psychosocial Care Center (CAPS - Centro de Atenção Psicossocial) user staff construction. METHOD: an ethnographic study. Data collection instruments were participant observation, field diary, semi-structured interviews and Sluzki's Minimal Map of Relationships. The research site was at a CAPS II of the city of São Paulo. Participants were CAPS user, their family network, professionals and other users. Data analysis took place through Minayo's thematic content analysis framework and Sluzki's personal maps. RESULTS: TF and NI led to greater social participation, autonomy and reorganization of family roles and treatment in CAPS. CONCLUSION: the TF associated with NI was potent in strengthening the user's personal/social network and in including them in community activities.

[Magnitude of social determinants in the risk of death from tuberculosis in Central-west Brazil]. / Magnitud de los determinantes sociales en el riesgo de mortalidad por tuberculosis en el Centro-Oeste de Brasil.

OBJECTIVE: To evaluate the magnitude of social determinants in areas of risk of mortality due to tuberculosis in a high incidence city. METHOD: Ecological study, which recruited the cases of tuberculosis deaths registered between 2006 and 2016 in the capital of Mato Grosso-Brazil. The social determinants were obtained from the Human Development Units. Sweep statistics were used to identify areas of risk of mortality due to tuberculosis. Principal component analysis was carried out to identify dimensions of social determinants. Multiple logistic regression was applied to verify associations between the dimensions of social determinants and the risk of mortality from tuberculosis. A 5% error was fixed. The standard error was established at 5% for all statistical tests. RESULTS: A total of 225 deaths due to tuberculosis were registered in the period, distributed heterogeneously in the space. A cluster of risk for tuberculosis mortality was identified, with RR=2.09 (95%CI: 1.48-2.94; p=0.04). Social determinants, low educational level and poverty were associated with the risk of mortality due to tuberculosis (OR: 2.92; 95%CI: 1.17-7.28). Income had a negative association with the risk of mortality due to tuberculosis (OR: 0.05; 95%CI: 0.00-0.70). The value of the ROC curve of the model was 92.1%. CONCLUSIONS: The results confirmed that the risk of mortality due to tuberculosis is a problem associated with social determinants. Health policies and social protection programmes can collaborate to address this problem.