A multilevel analysis of tuberculosis associated factors.
OBJECTIVE
Evaluating the association between TB and AIDS and estimating the determinant effects and factors for TB incidence rates in Brazilian metropolitan regions from 2001 to 2003.


METHODS
A Poisson longitudinal multilevel model was fitted to the annual TB case number by municipality and year, including the population as an offset variable, and AIDS incidence by metropolitan region, percentage low-income households, demographic density and TB cure rate by municipality and Brazilian geographic area as independent variables.


RESULTS
All variables were found to be significantly associated with tuberculosis (except for cure rate %): low income, demographic density, AIDS and Brazilian area. Interaction between AIDS and low income was significant and modified the effect of AIDS on TB incidence. Empty model and full model variance reduction percentages from first to third levels were 40.2%, 42.2% and 77.3%, respectively.


CONCLUSIONS
AIDS has become an impressive morbidity factor due to tuberculosis; this has not been found in previous studies in Brazil. The interaction between income and AIDS and the metropolitan regions' important contribution towards tuberculosis distribution were heterogeneously manifest amongst large Brazilian areas.
Gonçalves
Maria Jacirema Ferreira
MJ
Escola de Enfermagem de Manaus, Universidade Federal do Amazonas, Brasil. jaciremagoncalves@ufam.edu.br
Leon
Antonio Carlos Ponce de
AC
Penna
Maria Lúcia Fernandes
ML
D001938:Brazil / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D055361:Multilevel Analysis; D014376:Tuberculosis / Q000150:complications / Q000453:epidemiology*