Factors associated with the drug-resistant tuberculosis incidence rate in Brazil

Setting The selection and transmission of drug-resistant strains of tuberculosis (TB) hamper disease control. Objective To identify health conditions, demographic and socio-economic factors, as well as individual factors associated with the incidence of drug-resistant TB (DR-TB), in Brazil at the municipal level. Design This was an ecological study covering Brazilian municipalities that had reported DR-TB cases in 2014. Associations were evaluated in a multilevel analysis using negative binomial regression. Results In the multilevel model, males (incidence rate ratio [IRR] 2.6, 95% confidence interval [CI] 2.3-2.93) and Black persons (IRR 1.82, 95%CI 1.61-2.05) had a higher risk of DR-TB. Compared with those aged 60 years, persons aged 15-59 years (IRR 1.72, 95%CI 1.40-2.11) also had a higher risk. The following contextual factors were associated with the incidence rate (IR) of DR-TB: proportion of previously treated patients (IRR 1.27, 95%CI 1.1-1.5), acquired immune-deficiency syndrome IR (IRR 1.13, 95%CI 1.02-1.25), Municipal Human Development Index (IRR 0.72, 95%CI 0.64-0.81) and the Gini coefficient (IRR 0.86, 95%CI 0.78-0.95). Conclusion We have identified individual and contextual factors associated with the incidence of DR-TB. Our results may help improve integrated public health interventions aimed at controlling DR-TB in Brazil.