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All cases of TB or unspecified pneumonia deaths in children under 5 years of age reported between 2006 and 2016 were included and collected through Department of Informatics of the Unified Health System (Brazil\u2019s electronic database). The Spatial Scan Statistics was used to identify areas at higher risk of dying from this event. The spatial association was verified through the Getis-Ord techniques. The Bivariate Moran Global Index was used to verify the spatial autocorrelation between the two events. To identify the association of TB and pneumonia deaths with endemic areas of pulmonary TB and social determinants, four explanatory statistical models were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 21 391 cases of pneumonia and 238 cases of TB were identified. Spatial scanning analysis enabled the detection of four clusters of risk for TB (relative risk, RR, between 3.30 and 18.18) and 22 clusters for pneumonia (RR between 1.38 and 5.24). The spatial association of the events was confirmed (z-score 3.74 and 64.34) and spatial autocorrelation between events (Moran Index:0.031 (p=0.001)). The zero-inflated negative binomial distribution was chosen, and an association for both events was identified with the TB incidence rate (OR 5.3, 95% CI 2.85 to 9.84; OR 6.63, 95% CI 5.62 to 7.81), with the Gini Index (OR 1.78, 95% CI 1.12 to 2.82; OR 4.22, 95% CI 3.63 to4.92). Primary care coverage showed an inverse association for both events (OR 0.10, 95% CI 0.67 to 0.17; OR 0.18, 95% CI 0.15 to 0.21) for pneumonia). Finally, a family that benefited from the Bolsa Fam\u00edlia Programme had an inverse association for deaths from pneumonia (OR 0.81, 95% CI 0.52 to 1.25).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results do not just contribute to reduce mortality in children, but mainly contribute to prevent premature deaths through identification of critical areas in Brazil, which is crucial to qualify health surveillance services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-034074","type":"journal-article","created":{"date-parts":[[2020,8,21]],"date-time":"2020-08-21T06:23:22Z","timestamp":1597991002000},"page":"e034074","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Social determinants of deaths from pneumonia and tuberculosis in children in Brazil: an ecological study"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4163-8719","authenticated-orcid":false,"given":"Tha\u00eds Zamboni","family":"Berra","sequence":"first","affiliation":[{"name":"Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeir\u00e3o Preto, Brazil"}]},{"given":"Ivaneliza Simionato de","family":"Assis","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeir\u00e3o Preto, Brazil"}]},{"given":"Luiz Henrique","family":"Arroyo","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeir\u00e3o Preto, Brazil"}]},{"given":"Marcos Augusto Moraes","family":"Arcoverde","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeir\u00e3o Preto, Brazil"}]},{"given":"Josilene D\u00e1lia","family":"Alves","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeir\u00e3o Preto, Brazil"}]},{"given":"Laura Terenciani","family":"Campoy","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeir\u00e3o Preto, Brazil"}]},{"given":"Luana Seles","family":"Alves","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeir\u00e3o Preto, Brazil"}]},{"given":"Juliane de Almeida","family":"Crispim","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeir\u00e3o Preto, Brazil"}]},{"given":"Alexandre Tadashi Inomata","family":"Bruce","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeir\u00e3o Preto, Brazil"}]},{"given":"Yan Mathias","family":"Alves","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeir\u00e3o Preto, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5606-9478","authenticated-orcid":false,"given":"Felipe","family":"Lima dos Santos","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeir\u00e3o Preto, Brazil"}]},{"given":"Severina Alice","family":"da Costa Uch\u00f4a","sequence":"additional","affiliation":[{"name":"Department of Collective Health, Centro Universitario do Rio Grande do Norte, Natal, Brazil"}]},{"given":"Regina Celia","family":"Fiorati","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeir\u00e3o Preto, Brazil"}]},{"given":"Luis","family":"Lap\u00e3o","sequence":"additional","affiliation":[{"name":"International Public Health and Biostatistics, Universidade Nova de Lisboa, Lisboa, Portugal"}]},{"given":"Ricardo Alexandre","family":"Arc\u00eancio","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeir\u00e3o Preto, Brazil"}]}],"member":"239","published-online":{"date-parts":[[2020,8,20]]},"reference":[{"key":"2025121511062999000_10.8.e034074.1","doi-asserted-by":"crossref","unstructured":"Mouro F , Mosha N , Hildenwall H , et al . 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National guidelines on management of tuberculosis in children [online]. 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Sa\u00fade nas Am\u00e9ricas, Edi\u00e7\u00e3o de 2017. Resumo do panorama regional e perfil do Brasil. Washington, DC: Organiza\u00e7\u00e3o Pan-Americana da Sa\u00fade, 2017."},{"key":"2025121511062999000_10.8.e034074.9","doi-asserted-by":"crossref","unstructured":"Rossetto EV , Albuquerque LEJ . Relacionamento entre bases de dados para vigil\u00e2ncia da pandemia de influenza A (H1N1) pdm09, Brasil, 2009-2010. Cad Sa\u00fade P\u00fablica 2016;32.","DOI":"10.1590\/0102-311X00014115"},{"key":"2025121511062999000_10.8.e034074.10","doi-asserted-by":"crossref","first-page":"233","DOI":"10.3389\/fped.2019.00233","article-title":"Examining the complex relationship between tuberculosis and other infectious diseases in children","volume":"7","author":"Whittaker","year":"2019","journal-title":"Front Pediatr"},{"key":"2025121511062999000_10.8.e034074.11","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/S1473-3099(17)30703-X","article-title":"The global burden of tuberculosis: results from the global burden of disease study 2015","volume":"18","author":"Kyu","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"2025121511062999000_10.8.e034074.12","doi-asserted-by":"crossref","first-page":"e219","DOI":"10.1016\/S2214-109X(18)30478-9","article-title":"Effect of the Bolsa familia programme on the outcome of tuberculosis treatment: a prospective cohort study","volume":"7","author":"Oliosi","year":"2019","journal-title":"Lancet Glob Health"},{"key":"2025121511062999000_10.8.e034074.13","unstructured":"Rothman KJ , Greenland S , Lash TL . 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How high\/low clustering (Getis-Ord General G) works [online]. Available: https:\/\/pro.arcgis.com\/en\/pro-app\/tool-reference\/spatial-statistics\/h-how-high-low-clustering-getis-ord-general-g-spat.htm"},{"key":"2025121511062999000_10.8.e034074.19","doi-asserted-by":"publisher","DOI":"10.1111\/j.0016-7363.2005.00671.x"},{"key":"2025121511062999000_10.8.e034074.20","unstructured":"Environmental Systems Research Institute . How spatial autocorrelation (Global Moran\u2019s I) works [online]. 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Available: http:\/\/bvsms.saude.gov.br\/bvs\/publicacoes\/causas_sociais_iniquidades.pdf [Accessed 24 Jan 2020]."},{"key":"2025121511062999000_10.8.e034074.23","unstructured":"Comiss\u00e3o Nacional Sobre Determinantes Sociais da Sa\u00fade . As causas sociais das iniquidades em sa\u00fade no Brasil [online], 2008. Available: http:\/\/bvsms.saude.gov.br\/bvs\/publicacoes\/causas_sociais_iniquidades.pdf [Accessed 24 Jan 2020]."},{"key":"2025121511062999000_10.8.e034074.24","first-page":"19","article-title":"Determinantes sociais, econ\u00f4micos e ambientais da sa\u00fade. In Funda\u00e7\u00e3o Oswaldo Cruz. 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Doen\u00e7as transmiss\u00edveis e situa\u00e7\u00e3o socioecon\u00f4mica no Brasil: an\u00e1lise especial [online]. Bras\u00edlia, Rio de Janeiro: Ipea, 2016. Available: http:\/\/repositorio.ipea.gov.br\/bitstream\/11058\/7364\/1\/td_2263.pdf [Accessed 20 Feb 2019]."},{"key":"2025121511062999000_10.8.e034074.36","doi-asserted-by":"crossref","first-page":"53","DOI":"10.11606\/S1518-8787.2018052000131","article-title":"Oferta de servi\u00e7os pela aten\u00e7\u00e3o b\u00e1sica E detec\u00e7\u00e3o dA incid\u00eancia de tuberculose no Brasil","volume":"52","author":"Pelissari","year":"2018","journal-title":"Rev Sa\u00fade P\u00fablica"},{"key":"2025121511062999000_10.8.e034074.37","unstructured":"Campello T , Neri MC . Programa Bolsa Fam\u00edlia: uma d\u00e9cada de inclus\u00e3o e cidadania [Internet]. Bras\u00edlia: Ipea, 2013. 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