The incidence of tuberculosis and its relation to social inequalities: Integrative Review Study on PubMed Base

Bertolozzi, Maria Rita; Takahashi, Renata Ferreira; França, Francisco Oscar de Siqueira; Hino, Paula

doi:10.1590/2177-9465-EAN-2018-0367

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RESEARCH • Esc. Anna Nery 24 (1) • 2020 • https://doi.org/10.1590/2177-9465-EAN-2018-0367 copy

The incidence of tuberculosis and its relation to social inequalities: Integrative Review Study on PubMed Base

La incidencia de la tuberculosis y su relación con las desigualdades sociales: Estudio de revisión integradora en la Base PubMed

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to identify how the literature presents the relation between tuberculosis and social inequalities.

Method:

integrative review in which the combination of the descriptors “tuberculosis” and “social iniquity” guided the search for articles available in PubMed. A total of 274 articles were identified, and after reading the title and abstract, 13 studies were selected. The empirical material was analyzed according to the hermeneutics, highlighting the variables related to social inequalities, seeking to understand the main themes that embody the association between tuberculosis and social inequalities.

Results:

In general, the literature presents the social inequalities as factors that can interfere in the cure and/or control of the disease, such as age, income, unemployment, unskilled labor, access to health services, among others. Therefore, it does not include a deeper relationship between the organization of society and the production of the disease.

Conclusion and implications for practice:

A comprehensive understanding of tuberculosis disease is required, in order to expand interventions to support the control and elimination of the disease and, above all, the reduction of social inequalities. The understanding of tuberculosis as a disease enables expanding strategies to face it.

Keywords:
Community Health Nursing; Tuberculosis; Health Inequalities; Social Inequity; Public Health

Reference	Study scenario	Study design	Main results
Boccia D, Hargreaves J, Stavola BL: Fielding K, Schaap A: Godfrey-Faussett P et al. The association between household socioeconomic position and prevalent tuberculosis in Zambia: a case-control study. PLos ONE 201 l;6(6):e20824.⁷7 Boccia D, Hargreaves J, Stavola BL, Fielding K, Schaap A, Godfrey-Faussett P, et al. The association between household socioeconomic position and prevalent tuberculosis in Zambia: a case-control study. PLoS One [Internet]. 2011; [cited 2017 Jun 13]; 6(6):e20824. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3117783/pdf/pone.0020824.pdf. DOI: 10.1371/journal.pone.0020824 https://www.ncbi.nlm.nih.gov/pmc/article...	Zambia Africa	Case-control	Strong association between socioeconomic position and TB. Interventions such as food supply may strengthen the actions of disease control.
Rocha C. Montova R. Zevallos K. Curatola A, Ynga Ws Franco J, et al. The Innovative Socio-economic Interventions Against Tuberculosis (ISIAT) project: an operational assessment. Int J Tuberc Lung Dis 2011; 15(Suppl 2):S50-7.⁸8 Rocha C, Montoya R, Zevallos K, Curatola A, Ynga W, Franco J, et al. The Innovative Socio-economic Interventions Against Tuberculosis (ISIAT) project: an operational assessment. Int J Tuberc Lung Dis [Internet]. 2011 Jun; [cited 2017 Jun 13]; 15(Suppl 2):S50-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160483/pdf/ukmss-35471.pdf. DOI:10.5588/ijtld.10.0447 https://www.ncbi.nlm.nih.gov/pmc/article...	Lima Peru	Intervention	Interventions such as health care education, psychosocial support, professional training, food supply and money transfer contributed to the healing of disease.
Roza DL, Caccia-Bava MCGG, Martinez EZ. Spatio-temporal patterns of tuberculosis incidence in Ribeirao Preto, State of Sao Paulo, southeast Brazil, and their relationship with social vulnerability: a Bayesian analysis. Rev Soc Bras Med Trop 2012; 45(5):607-15.⁹9 Roza DL, Caccia-Bava MCGG, Martinez EZ. Spatio-temporal patterns of tuberculosis incidence in Ribeirão Preto, State of São Paulo, southeast Brazil, and their relationship with social vulnerability: a Bayesian analysis. Rev Soc Bras Med Trop [Internet]. 2012 Sep/Oct; [cited 2017 Jun 13]; 45(5):607-15. Available from: http://www.scielo.br/pdf/rsbmt/v45n5/v45n5a13.pdf http://www.scielo.br/pdf/rsbmt/v45n5/v45...	Ribeirão Preto Brazil	Ecological	The distribution of TB showed to be heterogeneous, in areas of greater risk and social vulnerability.
Basta PC, Marques M, Oliveira RL, Cunha EAT, Resendes APC, Souza-Santos R. Social inequalities and tuberculosis: analvsis by race color in Mato Grosso do Sul. Brazil. Rev Saúde Pública 2013;47(5):854-64.¹⁰10 Basta PC, Marques M, Oliveira RL, Cunha EAT, Resendes APC, Souza-Santos R. Social inequalities and tuberculosis: analysis by race/color in Mato Grosso do Sul, Brazil. Rev Saúde Pública [Internet]. 2013; [cited 2017 Oct 22]; 47(5):1-10. Available from: http://www.scielo.br/pdf/rsp/v47n5/en_0034-8910-rsp-47-05-0854.pdf. DOI: 10.1590/S0034-8910.2013047004628 http://www.scielo.br/pdf/rsp/v47n5/en_00...	Mato Grosso do Sul Brazil	Cross-sectional	It was observed that the incidence was six times greater in indigenous people, due to extreme povertv. It also noted a higher dropout rate between black and brown people.
Yamamura M, Santos Neto M, Freitas IM: Rodrigues LBB, Popolin MP: Uchoa SACs et al. Tuberculosis and social inequity in health: an ecological study using multivariate statistical techniques, São Paulo, Brazil. Rev Panam Salud Publica. 2014;35(4):270-7.¹¹11 Yamamura M, Santos Neto M, Freitas IM, Rodrigues LBB, Popolin MP, Uchoa SAC, et al. Tuberculosis and social inequity in health: an ecological study using multivariate statistical techniques, São Paulo, Brazil. Rev Panam Salud Publica [Internet]. 2014 Apr; [cited 2017 Jun 25]; 35(4):270-7. Available from: https://www.scielosp.org/article/rpsp/2014.v35n4/270-277 https://www.scielosp.org/article/rpsp/20...	São Paulo Brazil	Ecological	The social position reflects on the chance of falling ill with TB and on the access to health technologies. The Identification of the tuberculosis pattems and the social inequity indicators gave rise to discussions on the management and organization of a health system.
Laokri S: Dramaix-Wilmet M: Kassa F, Anagonou S, Dujardin B. Assessing the economic burden of illness for tuberculosis patients in Benin: determinants and consequences of catastrophic health expenditures and inequities. Trop Med Int Health 2014; 19(10):1249-58.¹²12 Laokri S, Dramaix-Wilmet M, Kassa F, Anagonou S, Dujardin B. Assessing the economic burden of illness for tuberculosis patients in Benin: determinants and consequences of catastrophic health expenditures and inequities. Trop Med Int Health [Internet]. 2014 Oct; [cited 2017 Jun 13]; 19(10):1249-58. Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1111/tmi.12365. DOI:10.1111/tmi.12365 https://onlinelibrary.wiley.com/doi/epdf...	Benin África	Cross- sectional	The burden of the falling ill with TB reflects on direct and indirect costs, as lost work days. It is worth stressing, as strategies to cope with the treatment, the sale of material goods and cuts in the domestic budget.
Mondai MNI. Nazrul HM: Chowdhury MRK: Howard J. Socio-demographic factors affecting knowledge levei of Tuberculosis patients in Rajshahi City, Bangladesh. Afr Health Sei 2014; 14(4): 855-65.¹³13 Mondal MNI, Nazrul HM, Chowdhury MRK, Howard J. Socio-demographic factors affecting knowledge level of Tuberculosis patients in Rajshahi City, Bangladesh. Afr Health Sci [Internet]. 2014 Dec; [cited 2017 Jun 13]; 14(4):855-65. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379806/pdf/AFHS1404-0855.pdf https://www.ncbi.nlm.nih.gov/pmc/article...	Rajshali Bangladesh	Cross- sectional	The knowledge about TB was considered to be unsatisfactory, being higher in persons with higher education and residents of the urban area. The greater the knowledge, the greater was the adherence to treatment.
Przvbylski G: Dabrowska A: Pilaczvnska-Cemel M, Krawiecka D. Unemployment in TB patients-ten-year observation at regional center of pulmonologv in Bvdgoszcz, Poland. Med Sei Monit 2014; 20:2125-31.¹⁴14 Przybylski G, Dabrowska A, Pilaczyńska-Cemel M, Krawiecka D. Unemployment in TB patients-ten-year observation at regional center of pulmonology in Bydgoszcz, Poland. Med Sci Monit [Internet]. 2014 Nov; [cited 2017 Jun 13]; 20:2125-31. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25362504. DOI: 10.12659/MSM.890709 https://www.ncbi.nlm.nih.gov/pubmed/2536...	Bydgoszcz Poland	Cross- sectional	The poverty is a risk factor for TB: and the unemployment is frequent among the affected patients. Therefore, the job opportunitv would contribute to reducing the inequality and declining the occurrence of the disease.
Munayco CV, Mújica OJ, León FX, Granado M: Espinal MA. Social determinants and inequalities in tuberculosis incidence in Latin America and the Caribbean. Rev Panam Salud Pública 2015; 38(3): 177-85.¹⁵15 Munayco CV, Mújica OJ, León FX, Granado M, Espinal MA. Social determinants and inequalities in tuberculosis incidence in Latin America and the Caribbean. Rev Panam Salud Pública [Internet]. 2015 Sep; [cited 2017 Nov 10]; 38(3):177-85. Available from: http://www.scielosp.org/pdf/rpsp/v38n3/v38n3a01.pdf http://www.scielosp.org/pdf/rpsp/v38n3/v...	Latin American and the Caribbean	Ecological	Countries that presented less expenditure on health.. reduced access to basic sanitation Services and lower life expectancy at birth had a higher incidence of TB. The disease control must address the social determinants, where the causes of the disease are found.
Zürcher K: Ballif M: Zwahlen M.. Rieder HL:Egger M, Fenner L. Tuberculosis Mortalitv and Living Conditions in Bem: Switzerland, 1856-1950. PLoS ONE 2016;11(2): e0149195.¹⁶16 Zürcher K, Ballif M, Zwahlen M, Rieder HL, Egger M, Fenner L. Tuberculosis Mortality and Living Conditions in Bern, Switzerland, 1856-1950. PLoS One [Internet]. 2016 Feb; [cited 2017 Jun 13]; 11(2):e0149195. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755532/. DOI: 10.1371/journal.pone.0149195 https://www.ncbi.nlm.nih.gov/pmc/article...	Bern Switzerland	Historical series	The TB mortalitv reduced from the improvements of living conditions and public health measures. Population density, dormitories with disabled direct sunlight, number of Windows, radiological exams, investigation in schools, among others, should be considered in the health conditions analvsis.
Gelaw SM. Socioeconomic Factors Associated with Knowledge on Tuberculosis among Adults in Ethiopia. Tuberc Res Treat_2016; 2016: 1-11.¹⁷17 Gelaw SM. Socioeconomic Factors Associated with Knowledge on Tuberculosis among Adults in Ethiopia. Tuberc Res Treat [Internet]. 2016; [cited 2017 Jun 13]; 2016:1-11. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753341/pdf/TRT2016-6207457.pdf. DOI: http://dx.doi.org/10.1155/2016/6207457 https://www.ncbi.nlm.nih.gov/pmc/article...	Ethiopia Africa	Cross-sectional	The levei of knowledge about the TB was considered low. It is important that the disease control actions consider education strategies on health addressed to the most vulnerable socio-economic groups, as women who live in rural areas, young people, socially disadvantaged people, with low or no education and unqualified workers.
Hargreaves JR, Boccia D, Evans CA: Adato M, Petticrew M, Porter J. The social detenninants of tuberculosis treatment adherence in a remote region of Papua New Guinea. Am J Public Health 2011; 101(4):654-62.¹⁸18 Hargreaves JR, Boccia D, Evans CA, Adato M, Petticrew M, Porter J. The social determinants of tuberculosis: from evidence to action. Am J Public Health [Internet]. 2011 Apr; [cited 2018 Jan 19]; 101(4):654-62. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052350/pdf/654.pdf https://www.ncbi.nlm.nih.gov/pmc/article...	Papua New Guinea	Exploratory	The low adherence to TB treatment was related to barriers as: difficulty in getting to health Service and necessity to work. Religious belief and confidence in the potential of the medications have been considered as facilities for the adherence.
San Predro A, Gibson G, Santos JPC, Toledo LM, Sabroza PC, Oliveira RM. Tuberculosis as a marker of inequities in the context of socio-spatial transformation. Rev Saúde Pública 2017;51:9.¹⁹19 San Pedro A, Gibson G, Santos JPC, Toledo LM, Sabroza PC, Oliveira RM. Tuberculosis as a marker of inequities in the context of socio-spatial transformation. Rev Saúde Pública [Internet]. 2017 Feb; [cited 2018 Jun 21]; 51:9. Available from: http://www.scielo.br/pdf/rsp/v51/0034-8910-rsp-S1518-87872017051006533.pdf. DOI: http://dx.doi.org/10.1590/s1518-8787.2017051006533 http://www.scielo.br/pdf/rsp/v51/0034-89...	Itaboraí Rio de Janeiro	Ecological	The TB heterogeneous distribution showed to be related to variables that reflect different life conditions dimensions, as consumption goods, habitation conditions and their surroundings, population agglomeration and distribution of incomes. It emphasizes the importance of the connection of the primarv health care network to reduce the disease burden.

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[1] Corresponding author: Paula Hino. E-mail: paulahino@yahoo.com.br