Gaceta Sanitaria (Feb 2004)
Factores sociales de riesgo para la falta de cumplimiento terapéutico en pacientes con tuberculosis en Pontevedra Social risk factors for noncompliance with tuberculosis treatment in Pontevedra [Spain]
Abstract
Objetivo: Conocer la prevalencia y características de los factores sociales de riesgo (FSR) para la falta de cumplimiento terapéutico entre los enfermos de tuberculosis de Pontevedra. Métodos: Análisis descriptivo de los enfermos de tuberculosis con FSR diagnosticados entre 1996 y 2002. Se consideró FSR la presencia de aislamiento social (alcoholismo, uso de drogas por vía parenteral, presidiario, sin domicilio fijo-sin techo, inadaptación social) o la inmigración. Se calculó la prevalencia y la tendencia anual de los FSR, la situación final de los pacientes y la influencia de la administración directamente observada del tratamiento en la situación final. Resultados: De los 775 casos de TB, 156 pacientes (20,1%) tenían algún FSR, 86 pacientes presentaban alcoholismo, 41 eran usuarios de drogas por vía parenteral, 24 eran inmigrantes, 14 no tenían domicilio fijo, 11 se consideraron con inadaptación social y 10 eran presidiarios. La presencia de FSR entre los enfermos de tuberculosis no mostró una tendencia a aumentar o disminuir durante el período de estudio, excepto por el incremento de inmigrantes (χ2 para la tendencia lineal = 12,24; p = 0,005). La proporciσn de pacientes con situaciσn final satisfactoria (curaciσn bacteriolσgica o tratamiento finalizado) fue significativamente mayor en el grupo de pacientes sin FSR (el 90,4 frente al 70,8%; p Objetive: To determine the prevalence and characteristics of social risk factors (SRF) for noncompliance with treatment in patients with tuberculosis (TB) in Pontevedra. Methods: We performed a descriptive analysis of patients with TB and SRF diagnosed between 1996 and 2002. A patient was considered as having SRF if he or she was socially isolated (alcoholism, intravenous drug use, prison inmate, homelessness or social maladjustment) or was an immigrant. The prevalence, annual trend of SRF and patient outcomes were calculated. The influence of direct observation of treatment administration on the outcome of patients with SRF was also analyzed. Results: Of 775 patients with TB, 156 (20.1%) had at least one SRF. Eighty-six patients were alcoholic, 41 were intravenous drug users, 24 were immigrants, 11 were homeless, 11 showed social maladjustment and 10 were prison inmates. The presence of SRF among TB patients showed no tendency to increase or decrease during the study period, except for the increasing number of immigrants (χ2 for lineal tendency = 12.24; p = 0.005). Final outcomes were significantly better in patients without SRF (90.4 vs 70.8% of satisfactory final outcomes; p < 0.001). Direct observation of treatment did not increase satisfactory outcomes in patients with SRF. Conclusions: Patients with TB and SRF have a significantly higher proportion of unsatisfactory final outcomes. The presence of SRF is relatively low in our environment. The number of immigrants from countries with a high prevalence of TB shows an incipient tendency to increase. This finding should be taken into account to achieve better control of the disease.
