Factors associated with cure when treating tuberculosis in the state of Rio de Janeiro, Brazil, 2011-2014

Santos, Janine Nascimento dos; Sales, Carolina Maia Martins; Prado, Thiago Nascimento do; Maciel, Ethel Leonor

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Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 27 (3) • 2018 • https://doi.org/10.5123/S1679-49742018000300015 copy

Factors associated with cure when treating tuberculosis in the state of Rio de Janeiro, Brazil, 2011-2014

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to analyze factors associated with cure when treating tuberculosis (TB) in the state of Rio de Janeiro, Brazil, from 2011 to 2014.

Methods:

this was a cross-sectional study with data from the Notifiable Diseases Information System (SINAN); logistic regression was used for data analysis.

Results:

of the 57,142 cases reported, 49,691 (86.96%) were included in the study; schooling ≥13 years (odds ratio (OR) 3.48; 95%CI 2.74;4.41) and residing in rural areas (OR 2.27; 95%CI 1.38; 3.73) were factors associated with a higher chance of cure; being male (OR 0.71; 95%CI 0.66;0.76) and brown skin color/race (OR 0.73; 95%CI 0.68;0.78) stood out as factors associated with less chance of cure.

Conclusion:

social and economic determinants were identified that influence the treatment outcome, evidencing the need for social support and guaranteed access to health services.

Keywords:
Tuberculosis; Public Policy; Social Vulnerability; Cross-Sectional Studies

Variables	n	%
Sex (n=41,275)
Male	26,634	65.0
Female	14,641	35.0
Age in years (n=41,279)
<20	4,059	9.9
20-39	18,180	44.0
40-59	14,244	34.5
≥60	4,796	11.6
Race/skin color (N=37,430)
White	14,506	39.0
Black	8,111	22.0
Brown	14,438	38.0
Other	375	1.0
Schooling, in years of study (n=28,656)
Illiterate	696	2.4
1-4	7,366	25.7
5-8	10,066	35.1
9-12	8,135	28.4
≥13	2,396	8.4
HIV/AIDS (n=27,901)
Yes	3,184	13.6
No	24,717	86.4
Alcoholism (n=34,156)
Yes	4,597	13.5
No	29,559	86.5
Diabetes (n=33,751)
Yes	2,745	8.1
No	31,006	91.9
Smoker (n=3,541)
Yes	332	9.4
No	3,209	90.6
Occupational disease (n=27,717)
Yes	738	2.7
No	26,979	97.3
Clinical form (n=41,279)
Pulmonary	35,067	85.0
Extra-pulmonary	4,879	11.8
Pulmonary + extrapulmonary	1,333	3.2
Place of residence (n=39,002)
Rural	424	1.1
Urban	38,578	98.9
Institutionalized (n=36,709)
No	34,153	93.0
Prison	1,290	3.5
Nursing home	59	0.2
Orphanage	72	0.2
Psychiatric hospital	89	0.2
Other	1,046	2.9
Type of admission (n=41,278)
New case	34,192	82.8
Recurrence	2,794	6.8
Return after abandonment	2,422	5.9
Unknown	204	0.5
Referral	1,666	4.0
X-rays (n=37,685)
Suspected	35,901	95.3
Normal	1,784	4.7
Sputum smear microscopy, 1st sample (n=31,175)
Positive	21,708	69.6
Negative	9,467	30.4
Sputum culture (n=6,056)
Positive	3,808	62.9
Negative	2,248	37.1
Supervised treatment (n=36,902)
Yes	16,047	44.1
No	20,345	55.9

Characteristics	Unfavorable outcome^b	Favorable outcome^c	OR^d crude (95%CI)^e	P Value^f	OR^d adjusted (95%CI)^e	P-Value adjusted^g
Characteristics	n (%)	n (%)	OR^d crude (95%CI)^e	P Value^f	OR^d adjusted (95%CI)^e	P-Value adjusted^g
LEVEL 1
Sex
Female	2,439 (16.6)	12,202 (83.4)	1.00	<0.001	1.00	<0.001
Male	6,230 (24.0)	20,404 (76.0)	0.65 (0.62;0.69)		0.71 (0.66;0.76)
Education level (in years of schooling)
Illiterate	167 (24.0)	529 (76.0)	1.00	<0.001	1.00	<0.001
1-4	1,729 (23.0)	5,637 (77.0)	0.28 (0.22;0.34)		1.08 (0.90;1.31)
5-8	2,363 (23.0)	7,703 (77.0)	0.28 (0.24;0.33)		1.11 (0.92;1.33)
9-12	1,161 (14 .0)	6,974 (86.0)	0.28 (0.24;0.33)		2.04 (1.68;2.47)
≥13	192 (8.0)	2,204 (92.0)	0.52 (0.44;0.61)		3.48 (2.74;4.41)
Race/skin color
White	2,251 (16.0)	12,255 (84.0)	1.00	<0.001	1.00	<0.001
Black	2,095 (26.0)	6,016 (74.0)	1.06 (0.80;1.40)		0.62 (0.57;0.67)
Brown	3,308 (23.0)	11,130 (77.0)	0.56 (0.42;0.74)		0.73 (0.68;0.78)
Other	61 (16.0)	314 (84.0)	0.65 (0.49;0.86)		1.03 (0.73;1.46)
Age (in years)
<20	670 (17.0)	3,389 (83.0)	1.00	<0.001	1.00	<0.001
20-39	4,321 (24.0)	13,859 (76.0)	1.15 (1.03;1.28)		0.65 (0.58;0.73)
40-59	2,792 (20.0)	11,452 (80)	0.73 (0.67;0.79)		0.97 (0.86;1.10)
≥60	889 (19.0)	3,907 (81)	0.93 (0.86;1.01)		1.08 (0.93;1.25)
LEVEL 2
Place of residence
Urban	8,139 (21.0)	30,439 (79.0)	1.00	<0.001	1.00	<0.001
Rural	46 (11.0)	378 (89.0)	0.45 (0.33;0.62)		2.27 (1.38;3.73)
Institutionalized
No	6,895 (20.0)	27,258 (80.0)	1.00	<0.001	1.00	<0.001
Prison	273 (21.0)	1,017 (79.0)	2.36 (2.08;2.68)		1.04 (0.80;1.34)
Nursing home	25 (42.0)	34 (58.0)	2.23 (1.86;2.68)		0.35 (0.15;0.83)
Orphanage	19 (26.0)	53 (74.0)	0.81 (0.48;1.38)		0.67 (0.29;1.55)
Psychiatric hospital	8 (9.0)	81 (91.0)	1.66 (0.97;2.85)		3.50 (0.82;14.9)
Other	391 (37.0)	655 (63.0)	6.04 (2.89;12.63)		0.40 (0.32;0.49)
Occupational Disease
No	5,536 (21.0)	21,443 (79.0)	1.00	0.001	1.00	0.116
Yes	116 (16.0)	622 (84.0)	1.38 (1.13;1.69)		1.24 (0.95;1.63)
LEVEL 3
HIV/AIDS
No	4,547 (18.0)	20,170 (82.0)	1.00	<0.001	1.00	0.260
Yes	1,290 (41.0)	1,894 (59.0)	0.33 (0.30;0.36)		0.73 (0.42;1.27)
Alcoholism
No	5,339 (18.0)	24,220 (82.0)	1.00	<0.001	1.00	0.123
Yes	1,539 (33.0)	3,058 (67.0)	0.44 (0.41;0.50)		0.65 (0.38;1.12)
Smoking
No	684 (21.0)	2,525 (79.0)	1.00	<0.001	1.00	0.081
Yes	134 (40.0)	198 (60.0)	0.40 (0.32;0.51)		0.50 (0.23;1.09)
Diabetes
No	6,324 (20.0)	24,682 (80.0)	1.00	<0.001	1.00	0.111
Yes	473 (17.0)	2,272 (83.0)	1.23 (1.11;1.36)		0.56 (0.28;1.14)
Other comorbidities
No	3,960 (18.0)	17,532 (82.0)	1.00	<0.001	1.00	0.895
Yes	1,511 (30.0)	3,447 (70.0)	0.51 (0.48; 0.55)		1.04 (0.56;1.96)
LEVEL 4
Notification Type
New case	5,939 (17.0)	28,253 (83.0)	1.00	<0.001	1.00	<0.001
Recurrence	733 (26.0)	2,061 (74.0)	1.87 (1.67;2.09)		0.55 (0.43;0.72)
Return after abandonment	1,390 (57.0)	1,032 (43.0)	1.10 (0.96;1.27)		0.21 (0.16;0.28)
Unknown	139 (68.0)	65 (32.0)	0.29 (0.25;0.33)		0.69 (0.03;13.9)
Referral	470 (28.0)	1,196 (72.0)	0.18 (0.13;0.25)		0.41 (0.28;0.60)
Supervised Treatment
No	4,227 (21.0)	16,118 (79.0)	1.00	0.001	1.00	0.307
Yes	3,110 (19.0)	12,937 (81.0)	1.09 (1.04;1.15)		0.91 (0.75;1.10)
Clinical form
Pulmonary	7,650 (22.0)	27,417 (78.0)	1.00	<0.001	1.00	0.624
Extra-pulmonary	642 (13.0)	4,237 (87.0)	1.43 (1.26;1.61)		1.22 (0.67;2.23)
Pulmonary + extrapulmonary	380 (29.0)	953 (71.0)	2.63 (2.28;3.04)		0.84 (0.51;1.39)
X-rays
Normal	257 (14.0)	1,527 (86.0)	1.00	<0.001	1.00	0.207
Suspected	7,454 (21.0)	28,447 (79.0)	0.64 (0.56;0.73)		1.51 (0.80;2.84)
Sputum smear microscopy (1st)
Negative	1,762 (19.0)	7,705 (81.0)	1.00	<0.001	1.00	0.005
Positive	4,731 (22.0)	16,977 (78.0)	0.82 (0.77;0.87)		0.73 (0.59;0.91)
Sputum culture
Negative	367 (16.0)	1,881 (84.0)	1.00	<0.001	1.00	<0.001
Positive	1,073 (28.0)	2,735 (72.0)	0.50 (0.44;0.57)		0.58 (0.47;0.71)

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence: Ethel Leonor Maciel - Av. Marechal Campos, No. 1468, Maruípe, Vitória, ES, Brazil. CEP: 29040-091 E-mail: ethel.maciel@gmail.com