Equity in health: tuberculosis in the Bolivian immigrant community of São Paulo, Brazil.
OBJECTIVE
To analyse the profile of tuberculosis (TB) among Bolivian immigrants, investigate the impact that this population has on the trends of TB and assess equity in access to TB treatment, in the city of São Paulo, Brazil.


METHODS
Descriptive study of the epidemiological profile of TB in four city districts with large Bolivian populations, comparing cases among Brazilians and Bolivians, during the 1998-2008 period was carried out. We used logistic regression to adjust the treatment outcome for potential confounders.


RESULTS
We identified 2056 new TB cases: 65.7% in Brazilians, 32.1% in Bolivians and 2.2% among other nationalities. Although TB incidence remained stable (high) over the study period, the annual proportion of cases among Bolivians increased from 15.0% to 53.0%. In comparison with the Brazilians, the Bolivians were younger (median age, 24 vs. 40 years; P < 0.0001) and presented a lower unemployment rate (3.1%vs. 11.6%; P < 0.0001), a lower rate of HIV co-infection (1.5%vs. 28.5%; P< 0.001), a higher proportion of individuals receiving supervised treatment (81.5%vs. 62.0%; P < 0.0001) and a higher proportion of cures (71.6%vs. 63.2%; P< 0.0001). After having been adjusted for potential confounder, cure after treatment was not associated with nationality.


CONCLUSIONS
Bolivian immigrants influenced the incidence but not the trends of TB among Brazilians in the study area. We found no significant differences between Bolivians and Brazilians regarding healthcare access or treatment outcome. Guaranteed universal health care access for all, including undocumented individuals, contributes to health equity. Specific intervention strategies are warranted for immigrants with tuberculosis.
Public Health School of University of São Paulo, São Paulo, Brazil  São Paulo Municipal Department of Health, São Paulo, Brazil.
Vanessa N
VN
Martinez
Naomi K
NK
Komatsu
Sumie M
SM
De Figueredo
Eliseu A
EA
Waldman
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001838:Bolivia / Q000208:ethnology; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D004651:Employment; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011640:Public Policy; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*; D055815:Young Adult