301682
Burden of tuberculosis and comorbidities in marginalized populations
Methods Residence in a slum, defined as aglomerados subnormais (AGSN), or incarcerated or homeless status were determined for all TB cases in Rio de Janeiro reported to the Brazilian Information System for Notifiable Diseases (SINAN) in 2010. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) based on the 2010 Global Burden of Disease methodology. DALY-gap was calculated as the difference between age-adjusted AGSN and non-AGSN DALYs/100,000 population.
Results Of 16,731 total TB DALYs for Rio de Janeiro (265.58 DALYs/100,000 population), DALYs from AGSN, incarcerated and homeless populations accounted for 25.4%, 2.6% and 1.4%, respectively. Proportion of DALYs for cases with at least one comorbidity was similar for AGSN (52.0%) and non-AGSN (53.0%), while DALYs/population for these cases were higher in AGSN communities (159.3 vs 125.2 DALYs/100,000). DALY-gap between AGSN and non-AGSN populations with TB with HIV infection, diabetes, mental illness or alcoholism was 34.5, 3.2, 2.0, 4.0 DALYs/100,000, respectively.
Conclusion Proportion of DALYs for TB cases with comorbidities was similar for those living in AGSN and non-AGSN communities in Rio de Janeiro. However, DALY-gap calculation unmasked a quantitative measure of disparity in disability that was not evident from traditional comparison of incidence or mortality between subpopulations.
Learning Areas:
Conduct evaluation related to programs, research, and other areas of practiceEpidemiology
Other professions or practice related to public health
Protection of the public in relation to communicable diseases including prevention or control
Learning Objectives:
Discuss the tuberculosis (TB) burden of disease (DALYs) contributed by marginalized populations (slum dwellers, incarcerated, and homeless) to the total TB disease burden of a region
Compare TB-associated comorbidities between slum versus non-slum communities as measured by DALYs and DALY-gap
Define DALY-gap as a new measurement for assessing health disparities
Keyword(s): Underserved Populations, Tuberculosis
Qualified on the content I am responsible for because: I am a PhD candidate in Epidemiology at the University of California, Berkeley, have published / am in the process of publishing numerous articles describing informal settlements in Brazil. I am fluent in Portuguese, have traveled to Brazil 6 times (3 for research) and will travel there next year with support of the Fulbright Student Program for 9 months. My scientific interests and thesis will involve a thorough description of disease burden in Brazil's slums.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.