{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T14:20:33Z","timestamp":1791382833686,"version":"4.3.3"},"reference-count":40,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Health","award":["NIHR134801"],"award-info":[{"award-number":["NIHR134801"]}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["225925\/Z\/22\/Z"],"award-info":[{"award-number":["225925\/Z\/22\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["305644\/Z\/23\/Z"],"award-info":[{"award-number":["305644\/Z\/23\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2025,6,3]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Residential segregation is considered a social determinant of health, but there is limited evidence of its impact on tuberculosis (TB). We investigated the associations between municipality-level income and racial segregation and TB treatment outcomes in Brazil.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We studied nationwide registries of new TB cases between 1 January 2010 and 31 December 2019. TB treatment was dichotomised as unfavourable (ie, loss to follow-up, modification of treatment regimen, treatment failure and death) and favourable (ie, cured\/treatment completion). We assessed individuals' municipality-level income and racial segregation (ie, dispersion of household heads earning \u2264half versus those earning &gt;half minimum wage; and of household heads identifying as black or brown\/mixed race (<jats:italic>Pardo\/a<\/jats:italic>) versus white). Logistic regression adjusted for sociodemographic and clinical variables was used to estimate the OR of experiencing an unfavourable treatment outcome associated with segregation overall and by self-identified race\/ethnicity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Individuals living in highly economically and racially segregated municipalities (fifth versus first quintiles) were more likely to have an unfavourable TB treatment outcome (income segregation: adjusted OR 1.34 (95% CI 1.31 to 1.37); racial segregation: 1.13 (0.94 to 1.36)). Living in municipalities of higher income segregation (third, fourth and fifth quintiles) was associated with higher unfavourable TB treatment outcomes in all self-identified racial groups (fifth quintile: white 1.25 (0.96 to 1.64); black 1.42 (1.15 to 1.74); brown\/mixed 1.37 (1.20 to 1.56); Asian=1.30 (1.00 to 1.69) and Indigenous 1.37 (1.00 to 1.87)).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Living in highly income and racially segregated environments is associated with unfavourable TB treatment outcomes for all self-identified races in Brazil. TB programmes should account for segregation as a barrier to TB treatment completion.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech-2024-223465","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T07:56:39Z","timestamp":1751874999000},"page":"779-786","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Associations of municipality-level income and racial segregation with individual-level tuberculosis treatment outcomes in Brazil: a nationwide cohort study (2010\u20132019)"],"prefix":"10.1136","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0343-6060","authenticated-orcid":false,"given":"Qanisha","family":"Hall","sequence":"first","affiliation":[{"name":"Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5057-385X","authenticated-orcid":false,"given":"Jos\u00e9 Firmino de","family":"Sousa Filho","sequence":"additional","affiliation":[{"name":"Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Goncalo Moniz, Fundacao Oswald Cruz (Fiocruz), Salvador, Bahia, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6283-1008","authenticated-orcid":false,"given":"Joanna MN","family":"Guimar\u00e3es","sequence":"additional","affiliation":[{"name":"Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Goncalo Moniz, Fundacao Oswald Cruz (Fiocruz), Salvador, Bahia, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah C","family":"Malta","sequence":"additional","affiliation":[{"name":"Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6881-6581","authenticated-orcid":false,"given":"Natalia Cristina","family":"Romero-Sandoval","sequence":"additional","affiliation":[{"name":"Faculdade de Ciencias Medicas de la Salud y Vida, Universidad Internacional del Ecuador, Quito, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Hargreaves","sequence":"additional","affiliation":[{"name":"Institute for Infection and Immunity, School of Health & Medical Sciences, City St George\u2019s, University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ligia","family":"Kerr","sequence":"additional","affiliation":[{"name":"Centro de Ciencias da Saude Comunitaria, Universidade Federal do Cear\u00e1, Fortaleza, Cear\u00e1, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gervasio F","family":"Santos","sequence":"additional","affiliation":[{"name":"Faculdade de Economia, Universidade federal da Bahia (UFBA), Salvador, Bahia, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth B","family":"Brickley","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4797-908X","authenticated-orcid":false,"given":"Enny S","family":"Paix\u00e3o","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK"},{"name":"Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Goncalo Moniz, Fundacao Oswald Cruz (Fiocruz), Salvador, Bahia, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maur\u00edcio L","family":"Barreto","sequence":"additional","affiliation":[{"name":"Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Goncalo Moniz, Fundacao Oswald Cruz (Fiocruz), Salvador, Bahia, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia M","family":"Pescarini","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK"},{"name":"Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Goncalo Moniz, Fundacao Oswald Cruz (Fiocruz), Salvador, Bahia, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"key":"2025100302174434000_79.10.779.1","unstructured":"Martins-Melo FR , Bezerra JMT , Barbosa DS . The burden of tuberculosis and attributable risk factors in Brazil, 1990\u20132017: results from the Global Burden of Disease Study 2017. World Health Organisation. Tuberculosis 2024."},{"key":"2025100302174434000_79.10.779.2","doi-asserted-by":"publisher","DOI":"10.1186\/s12963-020-00203-6"},{"key":"2025100302174434000_79.10.779.3","unstructured":"Global tuberculosis report 2022. 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