Impact of COVID-19 on Tuberculosis Indicators in Brazil: A Time Series and Spatial Analysis Study

Abstract

Background: We aimed to visualize and classify the time series of COVID-19, tuberculosis (TB) notification, and TB outcomes (cure, treatment abandonment, and death), verify the impact of the new coronavirus pandemic on these indices in Brazil, and verify the presence of spatial autocorrelation between COVID-19 and TB. Methods: This was an ecological time series study that considered TB and COVID-19 cases. Seasonal Trend Decomposition using Loess (STL) was used to trace the temporal trend, Prais–Winsten was used to classify the temporal trend, Interrupted Time Series (ITS) was used to verify the impact of COVID-19 on TB rates, and the Bivariate Moran Index (Global and Local) was used to verify the spatial autocorrelation of events. Results: Brazil and its macro-regions showed an increasing temporal trend for the notification of TB in the pre-pandemic period. Only the Northeast Region showed a decreasing temporal trend for cured cases. For treatment abandonment, all regions except for the Northeast showed an increasing temporal trend, and regarding death, Brazil and the Northeast Region showed an increasing temporal trend. With the ITS, COVID-19 caused a decline in TB notification rates and TB outcome rates. With the global spatial analysis, it was possible to identify the existence of spatial autocorrelation between the notification rate of COVID-19 and the TB notification rate and deaths. With the local analysis, it was possible to map the Brazilian municipalities and classify them according to the relationship between the rates of both diseases and space. Conclusions: COVID-19 influenced the follow-up of and adherence to TB treatment and intensified social vulnerability and, consequently, affected the notification of TB since the relationship between the disease and social determinants of health is already known. The restoration and strengthening of essential services for the prevention and detection of cases and treatment of TB in endemic environments such as Brazil have been oriented as a priority in the global health agenda.

Clusters da heterogeneidade da coinfecção tuberculose-HIV no Brasil: um estudo geoespacial

“…These factors have hindered the initiation and continuity of follow-up of people with tuberculosis and/or HIV. As a result, underdiagnosing and/or underreporting of these infections increased 20 , 50 as well as coinfection, which, in this study, had a 24% reduction in incidence compared with the previous biennium.…”

“…Once the significance of the I MG was proven, the univariate I LM was calculated, a type of local indicator of spatial association to identify clusters that influence the I MG , namely: high-high (HH), areas and neighboring areas with high coefficients; low-low (LL), areas and neighboring areas with low coefficients; low-high (LH), areas with low and neighboring areas with high coefficients; high-low (HL), areas with high and neighboring areas with low coefficients; and non-significant (NS), areas with no spatial trend 20 .…”

“…Then, a Spearman correlation matrix was constructed for the bivariate analysis, in which the variables were unable to present a significant association (p > 0.50), making it impossible to construct a regression model. Due to this, Moran’s bivariate analysis was used, which seeks to verify the association between two variables based on the values in neighboring regions 20 .…”

“…In Moran’s bivariate analysis, the clusters were classified as: HH, areas with high coefficients and indicators; LL, areas with low coefficients and indicators; LH, areas with low coefficients and high indicators; HL, areas with high coefficients and low indicators; and NS, areas with no association 20 . The analyses were performed in a Microsoft Excel ® 2016 spreadsheet and in GeoDa ® (version 1.20.0) and QGIS ® (version 2.36.3) software.…”

O Impacto Do Covid-19 Nos Casos Diagnosticados De Tuberculose No Município De Cascavel E Estado Do Paraná, Comparando Os Períodos De 2012 a 2022

“…Em relação aos indicadores de tuberculose (TB) no Brasil, foi estudado que o COVID-19 teve um impacto significativo nesses, influenciando o acompanhamento e a adesão ao tratamento da TB, levando a um declínio nas taxas de notificação de TB e nas taxas de resultados da TB, ressaltando a importância de abordar os determinantes sociais da saúde nos esforços de controle e prevenção da TB (BERRA et al, 2022).…”