One Health (Jun 2023)
Inequities between migrants and non-migrants with TB: Surveillance evidence from the Brazilian border State of Roraima
Abstract
Introduction: Until 2014, there was already a significant burden of TB in Roraima, with this State being among the most affected ones in Brazil. Since 2015, though, there has been a progressive increase in cases of TB in the state of Roraima, with a notorious concentration of cases in Venezuelan migrants. Active international migration in border territories should be seen as a warning signal about the need to strengthen health surveillance and One Health actions that encompass all components involved in the risk of active transmission of diseases as tuberculosis in these scenarios. Objective: This study aims to analyze and compare migrants and non-migrants notified with TB in the State of Roraima in Brazil and identify inequities in terms of diagnosis, access to treatment and outcome of the disease. Study design: Quantitative, cross-sectional, descriptive study of all confirmed cases of TB notified in the Information System for Notifiable Diseases (SINAN) between 2009 and 2019. Methods: Data were described through counts, frequencies, prevalence ratios and 95% confidence interval. We used Poisson regression with robust variance to adjust for confounders. Results: 2111 cases of TB were reported in Roraima between 2009 and 2019 and in this study (mean age 38.2 ± 18.5 years). Cases were more frequently males, brownish race, indigenous people, with high school level education. 10.9% (n = 181) of TB cases were migrants, mainly from Venezuela (72.9%). Migrants with TB were more prone to be homeless (PR = 3.7). A higher number of cases of readmission after treatment dropout (3.3%) and AIDS diseases (11.2%) was observed among migrants compared to non-migrants. The proportion of DR-TB was higher among migrants. The percent of cure of TB was lower among migrants and the prevalence of abandonment of treatment, transfers and deaths by other causes was higher compared to non-migrants. Conclusions: The results of the study have shown considerable differences in the epidemiological profile of TB between migrants and non-migrants living in the State of Roraima, with a tendency for poorer outcomes in the first ones as well as more concentration of vulnerabilities. These results stress out existing inequities between migrants and non-migrants with TB disease and raise questions on the health care network capacity to address these.
