Highlights
- •This study provides a complete picture of how fast active tuberculosis emerge in prison population.
- •The speed of becoming ill from tuberculosis increases when inmates are exposed to higher overcrowded settings.
- •Higher physical space per person in the cell increases the tuberculosis-free survival time.
- •This study supports the need for a drastic reduction in overcrowding and an increase in physical space to control tuberculosis in prison population.
Background
Environmental conditions play an important role in the high incidence of tuberculosis
in prisons. We estimated the effect of environmental factors, including measurements
based on cell dimensions, on the time to tuberculosis diagnosis in prison population
of Brazil.
Methods
This is a retrospective cohort of 2,257 prisoners diagnosed with tuberculosis in 2014
and 2015. We collected environmental data from 105 prisons and linked with routine
tuberculosis surveillance and prison data. We estimated tuberculosis-free survival
time with Cox risk models, guided by a validated directed acyclic graph.
Results
The median disease-free time was 1.71 years (95% confidence interval [95% CI] 1.64-1.78).
Each 50% increase in occupancy-rate, increased the tuberculosis speed incidence by
16% (95% CI 8%-25%) in the first 2 years, and 9% (95% CI 3%-16%) up to 5 years. An
increase in the cell area per person (ln[m2/person]) reduced the hazard of tuberculosis by 13% (95% CI 3%-23%) for up to 2, and
12% (95% CI 3%-21%) for up to 5 years.
Discussion
Most tuberculosis cases were diagnosed within 2 years of incarceration. Prison overcrowding
and physical space per person in the cell were associated with the tuberculosis-free
disease time.
Conclusions
Interventions to reduce overcrowding or increase physical space are crucial to prevent
tuberculosis in prisons.
Key Words
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References
- Tuberculosis incidence in prisons: a systematic review.PLoS Med. 2010; 7e1000381
Ministério da Saúde (BR), Departamento de Informática do SUS. Informações de saúde (TABNET): tuberculose. 2019. Accessed May 5, 2021. http://www2.datasus.gov.br/DATASUS/index.php?area=02
- Impact of incarceration on tuberculosis incidence and its interaction with income distribution inequality in Brazil.Trans R Soc Trop Med Hyg. 2020; 114: 23-30
- Evaluating strategies for control of tuberculosis in prisons and prevention of spillover into communities: an observational and modeling study from Brazil.PLoS Med. 2019; 16e1002737
- Prisons as reservoir for community transmission of tuberculosis, Brazil.Emerg Infect Dis. 2015; 21
- Smear positive pulmonary tuberculosis and HIV co-infection in prison settings of North Gondar Zone, Northwest Ethiopia.BMC Public Health. 2016; 16: 1091
- Risk factors for developing tuberculosis in remand prisons in St. Petersburg, Russia - a case-control study.Eur J Epidemiol. 2007; 22: 121-127
- Controlling tuberculosis in prisons against confinement conditions: a lost case? Experience from Cameroon.Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2011; 15 (i): 223-227
- Prevalence of tuberculosis and associated risk factors in the Central Prison of Mbuji-Mayi, Democratic Republic of Congo.Trop Med Health. 2016; 44: 30
- Tuberculosis in a South African prison - a transmission modelling analysis.South Afr Med J Suid-Afr Tydskr Vir Geneeskd. 2011; 101: 809-813
- The impact of ventilation and early diagnosis on tuberculosis transmission in Brazilian prisons.Am J Trop Med Hyg. 2015; 93: 739-746
- Modelling the impact of different tuberculosis control interventions on the prevalence of tuberculosis in an overcrowded prison.Asia Pac J Public Health. 2018; 30: 235-243
Ministério da Justiça (BR). Levantamento Nacional de Informações Penitenciárias — Infopen. 2017. Accessed May 5, 2021. http://dados.mj.gov.br/dataset/infopen-levantamento-nacional-de-informacoes-penitenciarias.
- Methodological issues in quantifying the magnitude of the tuberculosis problem in a prison population.Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2011; 15: 662-667
- Manual de Utilização do TBWEB- V 1.6.Secretaria de Saúde do Estado de São Paulo, São Paulo2008 (Accessed May 5, 2021.)
- Manual de intervenções ambientais para o controle da tuberculose em prisões.1st ed. Departamento Penitenciário Nacional, Brazil Rio de Janeiro2012 (Accessed May 15, 2021)
- Survival Analysis Reference Manual.Stata Press, Texas2021
Colosimo EA, Giolo SR. Análise de sobrevivência aplicada. 1st ed. Brazil [São Paulo]: Edgar Blücher, 2006. Portuguese.
- Survival Analysis.3rd ed. Springer, New York2012
- Causal diagrams for epidemiologic research.Epidemiol Camb Mass. 1999; 10: 37-48
- Are directed acyclic graphs (dags) an important tool to perform observational studies? reflections from a case in burned patients.Ann Burns Fire Disasters. 2018; 31: 73-74
- Robust causal inference using directed acyclic graphs: the R package ‘dagitty’.Int J Epidemiol. 2016; 45: 1887-1894
Textor J. Drawing and Analyzing Causal DAGs with DAGitty. 2015. Accessed September 26, 2021. http://www.dagitty.net/manual-2.x.pdf
- Modern Epidemiology.3rd ed. Brown and Company, Boston [MA]2008
- Household crowding as a potential mediator of socioeconomic determinants of tuberculosis incidence in Brazil.Plos One. 2017; 12e017611
Article Info
Publication History
Published online: May 26, 2022
Footnotes
Funding: F.A.D-Q. Beneficiary of a fellowship for research productivity from the National Council for Scientific and Technological Development - CNPq, process/contract identification: 312656/2019-0.
Conflicts of interest: None to report.
Identification
Copyright
© 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
