Social profile of the highest tuberculosis incidence areas in Portugal
I.. Francoa,
, P.. Sousab, M.. Gomesc, A.. Oliveirad, A.R.. Gaiod,e, R.. Duartea,b,f
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a Pulmonology Department, Hospital of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
b Department of Clinical Epidemiology, Predictive Medicine and Public Health, Medical School, University of Porto, Porto, Portugal
c Occupational Health and Safety Department, Hospital of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
d Department of Mathematics, Sciences School, University of Porto, Porto, Portugal
e Centre of Mathematics, University of Porto, Porto, Portugal
f EPI Unit, Institute of Public Health at University of Porto, Porto, Portugal
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Couceiro et al.<a href="#bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> showed that high risk of TB in some areas of Portugal was related to the high prevalence of HIV/AIDS, incarceration, nonstandard and/or crowded accommodation, unemployment and immigrant populations from countries with high TB incidence. A concentration of young adults might also contribute to the increase of the number of TB cases since the incidence is highest in individuals aged 25–44 years.<a href="#bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">, </span><a href="#bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">, </span><a href="#bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a></p><p class="elsevierStylePara">Realizing the importance of the social determinants in the control of TB, the authors wanted to characterize the profile of the Portuguese regions with higher incidence rates. The analyzed demographic and socio-economic factors included the population density, proportion of people at working age (15–64 years old), proportion of immigrants and unemployment rate and the TB incidence between 2002 and 2012 in Greater Oporto, Greater Lisbon and Setúbal Peninsula.</p><p class="elsevierStylePara">The territorial unit used was NUTS 3 (Nomenclatura das Unidades Territoriais para Fins Estatísticos). New TB cases were identified from the tuberculosis national surveillance system; unemployment rate values were obtained from the Employment and Vocational Training Institute reports and the remaining data were collected from National Statistics Institute database. The number of immigrants was only available from 2008 to 2012.</p><p class="elsevierStylePara">Greater Oporto presented the highest incidence of TB, followed by Greater Lisbon and Setúbal Peninsula. Until 2008, the decline of the incidence rate was higher in Oporto (81.16–37.69/100 000) than in Lisbon (63.82–35.10/100 000) and Setúbal (55.62–27.73/100 000). From that time onwards, the incidence curves became less pronounced and the three regions assumed closer values (34.39/100 000 in Setubal, 39.52/100 000 in Lisbon and 43.68/100 000 in Oporto) (<a href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a>). Also, from 2008 onwards, the decline of people of working age started to accelerate and the unemployment rate, which had been decreasing since 2002, showed a trend variation and started to increase.</p><a name="f0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="320v22n01-90447948fig1.jpg" alt="Variation of tuberculosis incidence rate, population density, proportion of people at working age and unemployment rate between 2002 and 2012, and proportion of immigrants between 2008 and 2012, in Greater Oporto, Greater Lisbon and Setúbal Peninsula."></img></p><p class="elsevierStylePara">Figure 1. Variation of tuberculosis incidence rate, population density, proportion of people at working age and unemployment rate between 2002 and 2012, and proportion of immigrants between 2008 and 2012, in Greater Oporto, Greater Lisbon and Setúbal Peninsula.</p><p class="elsevierStylePara">Regarding Oporto area, we can see that during the period studied the population density remained stable (1513.8–1522.5 population/km<span class="elsevierStyleSup">2</span>), and the proportion of people of working age (69.9–68.1%) and the proportion of immigrants (1.8–1.6%) decreased while the unemployment rate (7.0–13.4% of the labor force) increased. The Lisbon area presented the highest population density (1568.1–1625.4 population/km<span class="elsevierStyleSup">2</span>) with a definite increase over the years and the highest proportion of immigrants (8.8–8.4%). The proportion of people of working age (68.3–64.5%) and unemployment rate (5.5–8.8%) showed the lowest values for the three regions studied. The Setúbal area, although presenting the lowest population density (422.1–452.6 population/km<span class="elsevierStyleSup">2</span>), exhibited social and demographic characteristics very similar to those of Lisbon – the proportion of people of working age (69.3–65.4%) was quite close to that in Lisbon and the proportion of immigrants (6.0–5.2%) although not as high as in Lisbon was much higher than in Oporto. The unemployment rate (6.4–9.6%) however was higher than the one observed in Lisbon.</p><p class="elsevierStylePara">It is well known that the TB burden is strongly linked to socio-economic factors. From 2008 to 2012 there has been a slowing down in the decrease in the Portuguese TB incidence rate, in which the European and the national economic crisis have had an important role. In order to reach long-term TB control targets, efforts to address TB risk factors and social determinants are needed.<a href="#bib14" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">, </span><a href="#bib15" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> When looking at the three areas with the highest incidence in Portugal – all urban centers – we can see that they have different social profiles. Despite being the second largest urban center of the country, Oporto presents a lower number of individuals from qualified socio-economic groups with higher education<a href="#bib16" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a> and a higher unemployment rate than Lisbon. The latter is the main entry point for immigrants, many of them from sub-Saharan African countries with high TB incidence. Although less populated, Setúbal presents a considerable proportion of immigrants and a high unemployment rate due to its proximity to Lisbon. In these settings, TB control requires social, economic and environmental interventions that should be tailored according to each region profile: in Oporto the unemployed population must be addressed whereas in Lisbon and Setúbal the immigrant population is more relevant.</p><a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare.</p><p class="elsevierStylePara">Corresponding author. inesfranco_@hotmail.com</p>" "pdfFichero" => "320v22n01a90447948pdf001.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v22n01-90447948fig1.jpg" "Alto" => 2198 "Ancho" => 1785 "Tamanyo" => 861112 ] ] "descripcion" => array:1 [ "en" => "Variation of tuberculosis incidence rate, population density, proportion of people at working age and unemployment rate between 2002 and 2012, and proportion of immigrants between 2008 and 2012, in Greater Oporto, Greater Lisbon and Setúbal Peninsula." ] ] 1 => array:6 [ "identificador" => "fig2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "descripcion" => array:1 [ "en" => "Variation of tuberculosis incidence rate, population density, proportion of people at working age and unemployment rate between 2002 and 2012, and proportion of immigrants between 2008 and 2012, in Greater Oporto, Greater Lisbon and Setúbal Peninsula." ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib9" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Pulmonary tuberculosis space–time clustering and spatial variation in temporal trends in Portugal, 2000–2010: an updated analysis. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 8 | 15 |
| 2024 October | 34 | 29 | 63 |
| 2024 September | 38 | 47 | 85 |
| 2024 August | 41 | 51 | 92 |
| 2024 July | 30 | 33 | 63 |
| 2024 June | 44 | 33 | 77 |
| 2024 May | 34 | 29 | 63 |
| 2024 April | 27 | 23 | 50 |
| 2024 March | 25 | 18 | 43 |
| 2024 February | 21 | 27 | 48 |
| 2024 January | 20 | 19 | 39 |
| 2023 December | 13 | 24 | 37 |
| 2023 November | 19 | 31 | 50 |
| 2023 October | 16 | 34 | 50 |
| 2023 September | 20 | 32 | 52 |
| 2023 August | 11 | 10 | 21 |
| 2023 July | 14 | 21 | 35 |
| 2023 June | 17 | 23 | 40 |
| 2023 May | 57 | 33 | 90 |
| 2018 July | 2 | 0 | 2 |
| 2018 April | 2 | 0 | 2 |
| 2018 February | 2 | 0 | 2 |
| 2017 December | 2 | 0 | 2 |
| 2017 November | 2 | 0 | 2 |
| 2017 September | 2 | 0 | 2 |
| 2017 March | 2 | 0 | 2 |
| 2017 January | 4 | 0 | 4 |
| 2016 December | 2 | 0 | 2 |
| 2016 November | 0 | 1 | 1 |
| 2016 October | 4 | 0 | 4 |
| 2016 September | 7 | 2 | 9 |
| 2016 August | 2 | 0 | 2 |
| 2016 July | 3 | 2 | 5 |
| 2016 April | 38 | 8 | 46 |
| 2016 March | 64 | 46 | 110 |
| 2016 February | 107 | 91 | 198 |
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