Tuberculosis incidence strata in Cuban municipalities: 1999-2002 and 2003-2006

Objective. Identify Cuban municipalities with high, medium, and low incidence of tuberculosis (TB), compare incidence rates for the periods 1999-2002 and 2003-2006, and analyze distribution of the disease by population density and economic activity.Methods. TB incidence was calculated by municipality, confidence interval (95%), and the percentage of variation for the defined strata according to population density and the predominant economic activity. The municipalities were divided into three categories based on incidence (>= 10 per 100 000; >= 5 per 100 000 to < 10 per 100 000, and < 5 per 100 000), and maps were plotted.Results. The proportion of municipalities with an incidence of < 5 per 100 000 rose from 35.5% to 57.4% between the two periods, while the proportion of municipalities with an incidence of >= 10 per 100 000 fell from 22.5% to 5.9%. National incidence fell by 28.7%-from 8.7 per 100 000 in 1999-2002 to 6.2 in 2003-2006. Municipalities that were not very densely populated and where agricultural activities predominated showed significant reductions in incidence. The rates in densely populated municipalities devoted primarily to industrial and service activities are still high.Conclusions. TB incidence is gradually and sustainably declining in the majority of municipalities. Differentiated strategies are needed to reduce TB incidence rates in municipalities where they continue to be relatively high.