An unprecedented survey, carried out by the Oswaldo Cruz Foundation (Fiocruz), assessed the total impact of the tuberculosis epidemic on the population deprived of liberty. According to the analysis, the incarceration is the main risk factor for the disease in the region .
THE study was carried out in partnership with institutions in Argentina, Brazil, Colombia, Peru and the United States and was published on Tuesday (15) in the scientific journal The Lancet Public Health. The data was collected between 1990 and 2023 in the countries participating in the research, with the aim of understanding the impact of the increase in prisons on public health.
To achieve this, the study used dynamic transmission models, adjusted to historical and contemporary data on deprivation of liberty and tuberculosis in the countries analyzed. The analysis also used projections of the impact of various incarceration scenarios on the future incidence of tuberculosis in the general population.
The research found that the increase in deprivation of liberty since 1990 resulted in an estimated number of 34,393 excessive cases of tuberculosis incident in 2019 in the countries analyzed. That year, 27.2% of new cases were related to incarceration, more than the percentage attributable to any other risk factor, including HIV and malnutrition.
Furthermore, the analysis concluded that, compared to the current scenario of deprivation of liberty policies, interventions in this area could reduce the future incidence of tuberculosis in the general population of Brazil, Colombia, Argentina, El Salvador and Peru.
Tuberculosis is 26 times more common in incarcerated people
In Latin America, the population deprived of liberty has almost quadrupled in the last 30 years. Regarding tuberculosis, 10.6 million people developed the disease in 2022. Although the global incidence of tuberculosis has decreased by 8.7% since 2015, in Latin America the occurrence of tuberculosis cases has increased by 19% in the same period.
Persons deprived of their liberty, who may already be at high risk for tuberculosis prior to incarceration, are further exposed to prison conditions that promote the transmission and progression of the disease, such as overcrowding, poor ventilation, malnutrition, and limited access to health care.
Together, these factors contribute to tuberculosis rates being 26 times higher among people deprived of liberty than in the general population in South America.
Fewer people deprived of their liberty would mean less tuberculosis by 2034
To control tuberculosis in Latin America, researchers in the current study argue that international health agencies, ministries of justice, and national tuberculosis programs must collaborate to address the health crisis with comprehensive strategies that include decarceration.
The study also projected what could happen by 2034 in three different scenarios, in which rates of deprivation of liberty decrease in a controlled manner. In the first, the number of people deprived of their liberty and the time they are imprisoned would remain constant.
In the second scenario, prison entry rates and time spent deprived of liberty would continue to increase, as has been the case over the last 10 years. In the third, the number of people entering and the time spent in prison would be reduced by 25% or 50%, which, according to the study, could reduce tuberculosis cases in the future.
These simulations showed that Fewer people deprived of their liberty would mean less tuberculosis by 2034 which suggests that policies to reduce incarceration could have a positive impact on public health.
Study methodology
The researchers created an imaginary scenario in which the number of people deprived of their liberty would have remained the same as in 1990, and compared it with the real situation, in which there was an increase in the number of people incarcerated. According to the study, the comparison showed that the more people arrested, the greater the number of tuberculosis cases.
The research analyzed what percentage of tuberculosis is related to incarceration, mainly in people aged 15 and over. Calculations were made to see what would happen if the number of people deprived of their liberty was gradually reduced over the years, simulating a scenario where, by 2009, incarceration would be zero. After 10 years without new arrests, researchers calculated how many cases of tuberculosis would still occur in 2019.
The study’s estimates were compared with data from the World Health Organization (WHO), which show the five biggest risk factors for tuberculosis: malnutrition, HIV, alcoholism, smoking and diabetes. Although these factors vary by age and can overlap, the research highlights that the prison population is a very important risk factor.
Furthermore, the methodology identified places where excess cases occur and compared the results with estimates based on notifications in prisons. In six countries with different prison contexts, studies on the distribution and determinants of health problems, associated phenomena and processes show that deprivation of liberty is one of the main risk factors for tuberculosis.
According to the study, the true impact of deprivation of liberty on the tuberculosis epidemic across the region has been underestimated. The analysis also found that interventions aimed at deprivation of liberty can have effects on the broader tuberculosis epidemic in Latin America – much greater than previously observed.
The researchers highlight that these interventions should include not only strategies to reduce the risk of tuberculosis among currently and previously deprived individuals, but also efforts to end mass deprivation of liberty.
*With information from Fiocruz Agency
This content was originally published in Tuberculosis: incarceration is the main risk factor in Latin America on the CNN Brasil website.
Source: CNN Brasil
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