Social determinants of health and unfavourable outcome of tuberculosis treatment in the prison system

Abstract 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.摘要：本研究旨在基于健康社会决定因素视角，分析被剥夺自由人群的结核病治疗不良结局。本回顾性队列研究于巴西朗多尼亚州与圣保罗州开展，研究对象为2008年至2017年间通报的结核病在押人员。研究数据取自SINAN与TB-WEB，采用相对危险度（relative risk, RR）及95%置信区间（95%CI）进行统计分析，以此检验因变量（不良结局：结核病及其他病因死亡、原发性与非原发性失访 vs. 良好结局：治愈）与健康的结构性及中间性决定因素之间的关联。朗多尼亚州共记录158例不良结局，圣保罗州则为2227例。在朗多尼亚州，该不良结局与性别（RR=3.09；95%CI：1.03~9.27）及艾滋病（Acquired Immune Deficiency Syndrome, AIDS）感染（RR=2.46；95%CI：1.63~3.71）显著相关。在圣保罗州，年龄超过30岁（RR=1.36；95%CI：1.26~1.47）、艾滋病感染（RR=3.08；95%CI：2.81~3.38）、酒精滥用（RR=1.54；95%CI：1.35~1.76）、糖尿病（RR=1.70；95%CI：1.27~2.28）以及自行服药治疗（RR=2.55；95%CI：2.27~2.86）均为结核病治疗不良结局的危险因素。本研究可为监狱机构内结核病患者的风险分层提供科学依据，进而优化医疗干预以改善结核病治疗的良好结局。