Socio-sanitary inequalities and tuberculosis: an analysis on intra-urban endemic area in Brazil

INTRODUCTION: The precarious living conditions in urban settings associated with the ocurrence of tuberculosis highlights a context of social inequalities in health, which emphasizes the deepening inequalities socio-sanitary, especially in areas under intense pressure for transformation on urban landscape. The present study aims to analyze the relationship between the occurrence of tuberculosis and socio-sanitary and health care quality indicators of the disease, as well as discuss the influence of the variation of these indicators in the distribution of tuberculosis in the period 2000-2011.

METHODS: We designed an ecological study, whose territorial units of analysis were the 77 districts of Itaboraí, State of Rio de Janeiro. The county has been experiencing major transformations of its urban landscape due to the implementation of the largest petrochemical industrial complex in Latin America. Data were analyzed using generalized linear models.

RESULTS:   In the period from 2000 to 2011, there was significant direct association between the tuberculosis incidence and some socioeconomic indicators like density of poor people, households connected to sewage network, inequality of income distribution (Theil index) as well as intra-household density.

CONCLUSIONS:   Our findings suggest that economic development in the study area was accompanied by a widening of socioeconomic inequalities in the period, resulting in different forms of exposure and illness to tuberculosis, associated to the new social organization of urban settings. In general terms, the lack of public policies seeking to eliminate social inequalities for populations living in vulnerable socioeconomic conditions to tuberculosis tend to even more restrict the resolution of the problem, leading to overload the local programs for disease control.