title: Tuberculosis DALY-Gap: Spatial and Quantitative Comparison of Disease Burden Across Urban Slum and Non-slum Census Tracts.
abstract: To quantitatively assess disease burden due to tuberculosis between populations residing in and outside of urban informal settlements in Rio de Janeiro, Brazil, we compared disability-adjusted life years (DALYs), or "DALY-gap." Using the 2010 Brazilian census definition of informal settlements as aglomerados subnormais (AGSN), we allocated tuberculosis (TB) DALYs to AGSN vs non-AGSN census tracts based on geocoded addresses of TB cases reported to the Brazilian Information System for Notifiable Diseases in 2005 and 2010. DALYs were calculated based on the 2010 Global Burden of Disease methodology. DALY-gap was calculated as the difference between age-adjusted DALYs/100,000 population between AGSN and non-AGSN. Total TB DALY in Rio in 2010 was 16,731 (266 DALYs/100,000). DALYs were higher in AGSN census tracts (306 vs 236 DALYs/100,000), yielding a DALY-gap of 70 DALYs/100,000. Attributable DALY fraction for living in an AGSN was 25.4%. DALY-gap was highest for males 40-59 years of age (501 DALYs/100,000) and in census tracts with <60% electricity (12,327 DALYs/100,000). DALY-gap comparison revealed spatial and quantitative differences in TB burden between slum vs non-slum census tracts that were not apparent using traditional measures of incidence and mortality. This metric could be applied to compare TB burden or burden for other diseases in mega-cities with large informal settlements for more targeted resource allocation and evaluation of intervention programs.
authors.affiliation: Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, 530E Li Ka Shing Health Center, Berkeley, CA, 94720, USA, mmarlow3@gmail.com.
authors.forename: Mariel A
authors.initials: MA
authors.lastname: Marlow
authors.forename: Ethel Leonor Noia
authors.initials: EL
authors.lastname: Maciel
authors.forename: Carolina Maia Martins
authors.initials: CM
authors.lastname: Sales
authors.forename: Teresa
authors.initials: T
authors.lastname: Gomes
authors.forename: Robert E
authors.initials: RE
authors.lastname: Snyder
authors.forename: Regina Paiva
authors.initials: RP
authors.lastname: Daumas
authors.forename: Lee W
authors.initials: LW
authors.lastname: Riley
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D019057:Quality-Adjusted Life Years; D012737:Sex Factors; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult
references.citation: Am J Public Health. 2011 Mar;101(3):517-23
references.pmid: 21233437
references.citation: J Urban Health. 2011 Jun;88 Suppl 2:S200-18
references.pmid: 21713553
references.citation: BMC Public Health. 2010;10:45
references.pmid: 20113463
references.citation: PLoS Med. 2007 Oct;4(10):1561-6
references.pmid: 17958462
references.citation: Health Policy. 2013 Jun;111(1):99-104
references.pmid: 23608637
references.citation: Epidemiol Rev. 2001;23(2):288-301
references.pmid: 12192738
references.citation: Braz J Infect Dis. 2013 Mar-Apr;17(2):218-33
references.pmid: 23474189
references.citation: Health Place. 2014 Jan;25:56-67
references.pmid: 24269879
references.citation: J Urban Health. 2014 Jun;91(3):432-45
references.pmid: 24297475
references.citation: Lancet. 2012 Dec 15;380(9859):2129-43
references.pmid: 23245605
references.citation: Semin Fetal Neonatal Med. 2009 Aug;14(4):234-40
references.pmid: 19303830
references.citation: Lancet. 2012 Dec 15;380(9859):2197-223
references.pmid: 23245608
references.citation: Lancet Neurol. 2009 Apr;8(4):345-54
references.pmid: 19233730
references.citation: BMC Public Health. 2008;8:116
references.pmid: 18402698
references.citation: Int J Epidemiol. 2009 Apr;38(2):470-7
references.pmid: 19047078
references.citation: Aust N Z J Public Health. 2013 Jun;37(3):218-25
references.pmid: 23731103
references.citation: BMC Int Health Hum Rights. 2007 Mar 07;7:2
references.pmid: 17343758
references.citation: Lancet. 2012 Dec 15;380(9859):2063-6
references.pmid: 23245602
references.citation: Popul Health Metr. 2008 Mar 10;6:1
references.pmid: 18331630
references.citation: PLoS One. 2012;7(9):e44980
references.pmid: 23028718