摘要：OBJETIVO: Analisar características sociodemográficas e clínico- epidemiológicas dos casos de tuberculose e fatores associados ao abandono e ao óbito na vigência do tratamento. MÉTODOS: Estudo epidemiológico baseado em dados notificados de tuberculose em indígenas e não indígenas, segundo raça/cor, em Mato Grosso do Sul, entre 2001 e 2009. Realizou-se análise descritiva dos casos de acordo com as variáveis sexo, faixa etária, zona de residência, exames empregados para o diagnóstico, forma clínica, tratamento supervisionado e situação de encerramento, segundo raça/cor. Utilizou-se análise univariada e múltipla por meio de regressão logística para identificar preditores de abandono e óbito, e odds ratio como medida de associação. Foi construída série histórica de incidência, segundo raça/cor. RESULTADOS: Registraram-se 6.962 casos novos de tuberculose no período, 15,6% entre indígenas. Houve predomínio em homens e adultos (20 a 44 anos) em todos os grupos. A maior parte dos doentes indígenas residia na zona rural (79,8%) e 13,5% dos registros nos indígenas ocorreram em < 10 anos. A incidência média no estado foi 34,5/100.000 habitantes, 209,0; 73,1; 52,7; 23,0 e 22,4 entre indígenas, amarelos, pretos, brancos e pardos, respectivamente. Doentes de 20 a 44 anos (OR = 13,3; IC95% 1,9;96,8), do sexo masculino (OR = 1,6; IC95% 1,1;2,3) e de raça/cor preta (OR = 2,5; IC95% 1,0;6,3) mostraram associação com abandono de tratamento, enquanto doentes > 45 anos (OR = 3,0; IC95% 1,2;7,8) e com a forma mista (OR = 2,3; IC95% 1,1;5,0) apresentaram associação com óbito. Apesar de representarem 3,0% da população, os indígenas foram responsáveis por 15,6% das notificações no período. CONCLUSÕES: Houve importantes desigualdades em relação ao adoecimento por tuberculose entre as categorias estudadas. As incidências nos indígenas foram consistentemente maiores, chegando a exceder em mais de seis vezes as médias nacionais. Entre pretos e pardos, piores resultados no tratamento foram observados, pois apresentaram chance de abandono duas vezes maior que os indígenas. O mau desempenho do programa também esteve fortemente associado ao abandono e ao óbito. Acredita-se que, enquanto não se reduzir a pobreza, as desigualdades nos indicadores em saúde permanecerão.
其他摘要：OBJECTIVE: To describe the sociodemographic and clinical-epidemiological characteristics of tuberculosis cases and identify associated factors with abandoning treatment and death whilst undergoing treatment. METHODS: Epidemiological study based on cases of tuberculosis recorded in indigenous and non-indigenous individuals according to race/color in Mato Grosso do Sul, Midwestern Brazil, between 2001 and 2009. Descriptive analysis of the cases was carried out according to the variables of sex, age group, residence, type of test used in the diagnosis, clinical form, supervised treatment and final status, according to race/color. Univariate/multivariate logistic regression analyses were used to identify predictors of abandoning treatment and death, using odds ratio as a measure of association. A time series of incidence according to race/color was constructed. RESULTS: In the period, 6,962 new cases of tuberculosis were registered, 15.6% being among indigenous. The illness was predominantly found in men and adults (20-44 years old) in all groups. Most of the indigenous patients lived in rural areas (79.8%) and 13.5% of the records in indigenous occurred in children aged < 10 years. The average incidence in the state was 34.5/100,000 inhabitants, being 209.0, 73.1, 52.7, 23.0 and 22.4 in indigenous, and those with yellow, black, white and brown skin, respectively. Patients aged 20 to 44 years (OR = 13.3, 95%CI 1.9;96.8), male (OR = 1.6, 95%CI 1.1;2.3) and of black race/ color (OR = 2.5, 95%CI 1.0;6.3) were associated with abandoning treatment, while patients aged > 45 years (OR = 3.0, 95%CI 1.2;7.8) and with the mixed form (OR = 2.3, 95%CI 1.1;5.0) showed association with death. Although they only account for 3.0% of the population, the indigenous were responsible for 15.6% of cases recorded during the period. CONCLUSIONS: Major inequalities in the tuberculosis illness process were found between the categories studied. Incidence in the indigenous population was consistently higher than recorded in any other group, reaching more than six times the national average. It was among those with black and brown skin that the worst treatment results were observed, as they were twice as likely to abandon treatment as the indigenous. Poor program performance was strongly associated with abandoning treatment and death. It is thought that as long as there is no reduction in poverty inequalities in health indicators will remain.
关键词：Tuberculose; epidemiologia; População Indígena; Origem Étnica e Saúde; Fatores Socioeconômicos; Desigualdades em Saúde.
其他关键词：Tuberculosis; epidemiology; Indigenous Population; Ethnicity and Health. Socioeconomic Factors; Health Inequalities.
