142nd APHA Annual Meeting and Exposition

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Burden of tuberculosis and comorbidities in marginalized populations

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Sunday, November 16, 2014

Mariel Marlow, PhD, MPH , Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA
Robert Snyder, MPH , Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA
Ethel Leonor Noia Maciel, PhD , Federal University of Espírito Santo, Vitória, Brazil
Regina Daumas, PhD , National School of Public Health, Oswaldo Cruz Foundation – FIOCRUZ, Rio de Janeiro, Brazil
Lee Riley, MD , Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, Brazil
Background Disability-adjusted life years (DALYs) data can be disaggregated to compare disease burden in subpopulations within the same urban setting. Here, we investigated the burden of tuberculosis (TB) and associated comorbidities in marginalized populations by calculating TB DALYs and DALY-gap between slum and non-slum populations in the city of Rio de Janeiro, Brazil.

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 practice
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

Presenting author's disclosure statement:

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.