大规模监禁是拉丁美洲结核病流行的驱动因素以及替代政策的预期效果：数学建模研究

IF 25.4 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Public Health Pub Date : 2024-10-15 DOI:10.1016/s2468-2667(24)00192-0

Yiran E Liu, Yasmine Mabene, Sergio Camelo, Zulma Vanessa Rueda, Daniele Maria Pelissari, Fernanda Dockhorn Costa Johansen, Moises A Huaman, Tatiana Avalos-Cruz, Valentina A Alarcón, Lawrence M Ladutke, Marcelo Bergman, Ted Cohen, Jeremy D Goldhaber-Fiebert, Julio Croda, Jason R Andrews

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引用次数: 0

摘要

背景拉丁美洲的结核病发病率正在上升，自 1990 年以来，该地区的监禁人口几乎翻了两番。在这项建模研究中，我们根据阿根廷、巴西、哥伦比亚、萨尔瓦多、墨西哥和秘鲁的历史和当代数据校准了动态分区传播模型，这些国家约占该地区监禁人口和结核病负担的 80%。每个国家的模型都是根据 1990 年至 2023 年的监禁和结核病数据独立拟合的（具体日期取决于国家）。该模型不包括艾滋病毒、耐药性、性别或年龄结构。利用历史反事实情景，我们估算出了监禁的传播人口可归因分数（tPAF），以及自 1990 年以来监禁流行率上升所造成的超额人口负担。此外，我们还预测了其他监禁政策对未来人口结核病发病率的影响。研究结果如果没有 1990 年以来监禁率的上升，2019 年的人口结核病发病率比预期高出 29-4%（95% 不确定区间 [UI] 23-9-36-8），相当于各国超额发病 34 393 例（28 295-42 579 例）。2019 年的监禁 tPAF 为 27-2%（20-9-35-8），超过了对其他风险因素（如艾滋病毒、酒精使用障碍和营养不良）的估计。与监禁率稳定在当前水平的情况相比，如果到 2034 年监狱收监人数和监禁时间逐步减少 50%，那么除墨西哥外，所有国家的结核病发病率都将下降 10%以上。国际卫生机构、司法部和国家结核病计划应通力合作，采取包括解除监禁在内的综合策略来应对这一健康危机。

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Mass incarceration as a driver of the tuberculosis epidemic in Latin America and projected effects of policy alternatives: a mathematical modelling study

Background

Tuberculosis incidence is increasing in Latin America, where the incarcerated population has nearly quadrupled since 1990. We aimed to quantify the impact of historical and future incarceration policies on the tuberculosis epidemic, accounting for effects in and beyond prisons.

Methods

In this modelling study, we calibrated dynamic compartmental transmission models to historical and contemporary data from Argentina, Brazil, Colombia, El Salvador, Mexico, and Peru, which comprise approximately 80% of the region's incarcerated population and tuberculosis burden. The model was fit independently for each country to incarceration and tuberculosis data from 1990 to 2023 (specific dates were country dependent). The model does not include HIV, drug resistance, gender or sex, or age structure. Using historical counterfactual scenarios, we estimated the transmission population attributable fraction (tPAF) for incarceration and the excess population-level burden attributable to increasing incarceration prevalence since 1990. We additionally projected the effect of alternative incarceration policies on future population tuberculosis incidence.

Findings

Population tuberculosis incidence in 2019 was 29·4% (95% uncertainty interval [UI] 23·9–36·8) higher than expected without the rise in incarceration since 1990, corresponding to 34 393 (28 295–42 579) excess incident cases across countries. The incarceration tPAF in 2019 was 27·2% (20·9–35·8), exceeding estimates for other risk factors like HIV, alcohol use disorder, and undernutrition. Compared with a scenario where incarceration rates remain stable at current levels, a gradual 50% reduction in prison admissions and duration of incarceration by 2034 would reduce population tuberculosis incidence by over 10% in all countries except Mexico.

Interpretation

The historical rise in incarceration in Latin America has resulted in a large excess tuberculosis burden that has been under-recognised to date. International health agencies, ministries of justice, and national tuberculosis programmes should collaborate to address this health crisis with comprehensive strategies, including decarceration.

Funding

National Institutes of Health.

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来源期刊

Lancet Public Health Medicine-Public Health, Environmental and Occupational Health

CiteScore

55.60

自引率

0.80%

发文量

305

审稿时长

8 weeks

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