Infectious Disease
Social margination index and unsuccessful pulmonary tuberculosis treatment outcomes in Sonora, Mexico Gregorio Morales* Gregorio Morales Morales Universidad del Valle de México
Introduction: Pulmonary tuberculosis remains a global public health problem. In Mexico, Sonora in the northwestern of the country, ranks among the highest in incidence and mortality. While individual-level factors have been associated with poor outcomes, the role of contextual factors is still unclear.
Methods: We conducted an ecological study to assess the relation between an Index of Social Marginalization and municipality rates of non-successful treatment outcomes (treatment failure, loss to follow-up, and mortality) among adults with pulmonary tuberculosis susceptible to conventional drug treatment, in Sonora from 2019 to 2023. Poisson regression models were fitted to estimate RR and 95% CI.
Results: Thirty-nine out of 72 municipalities registered pulmonary tuberculosis cases (n=2665) during the study period. Higher rates of non-successful outcomes were observed in municipalities with lower levels of social marginalization. No association was found between the Index of Social Marginalization and treatment failure or loss to follow-up; however, a strong association was observed with pulmonary tuberculosis mortality, with rate ratios ranging from 1.37 (95% CI: 1.23–1.53) in the overall analysis to 1.82 (95% CI: 1.52–2.20) in a sub analysis that include municipalities with the greater rates.
Discussion: The excess mortality observed in less marginalized municipalities suggests that the relationship between social marginalization and pulmonary tuberculosis outcomes is complex and can be influenced by urban dynamics, population concentration, and microcontexts of vulnerability not fully captured at the municipal level. Given the limitations of ecological analyses, these findings highlight the need for more granular geographic analyses and targeted interventions in high-burden areas.