Pulmonary tuberculosis in São Luis, State of Maranhão, Brazil: space and space-time risk clusters for death (2008-2012)

Abstract

Introduction:The objective was to identify space and space-time risk clusters for the occurrence of deaths in a priority city for the control of tuberculosis (TB) in the Brazilian Northeast. Methods: Ecological research was undertaken in the City of São Luis/ Maranhão. Cases were considered that resulted in deaths in the population living in the urban region of the city with pulmonary TB as the basic cause, between 2008 and 2012. To detect space and space-time clusters of deaths due to pulmonary TB in the census sectors, the spatial analysis scan technique was used. Results: In total, 221 deaths by TB occurred, 193 of which were due to pulmonary TB. Approximately 95% of the cases (n=183) were geocoded. Two signifi cant spatial clusters were identifi ed, the fi rst of which showed a mortality rate of 5.8 deaths per 100,000 inhabitants per year and a high relative risk of 3.87. The second spatial cluster showed a mortality rate of 0.4 deaths per 100,000 inhabitants per year and a low relative risk of 0.10. A signifi cant cluster was observed in the space-time analysis between 11/01/2008 and 04/30/2011, with a mortality rate of 8.10 deaths per 100,000 inhabitants per year and a high relative risk (3.0). Conclusions: The knowledge of priority sites for the occurrence of deaths can support public management to reduce inequities in the access to health services and permit an optimization of the resources and teams in the control of pulmonary TB, providing support for specifi c strategies focused on the most vulnerable populations.Keywords: Pulmonary tuberculosis. Spatio-temporal and spatial analysis. Death.Tuberculosis (TB) is one of the main causes of death among infectious contagious diseases and occurs mainly in developing countries (1) . In 2012, 1.3 million people died of TB worldwide. Brazil ranked 16 th in the number of cases and 109 th in terms of incidence rate(1) , with 36.1 cases per 100,000 inhabitants and a mortality rate of 2.4 deaths per 100,000 inhabitants (2) .It is notable that among the clinical forms of the disease, pulmonary tuberculosis (PTB) is on the list of avoidable causes of death because if the local health services established appropriate health promotion, protection and recovery actions for patients and their families, deaths from TB would be less common (3) .Considered a social disease (4) , TB should be studied from a microregional, local and focal viewpoint, according to the spatial distribution (5) . Therefore, a geo-epidemiological approach to the disease, using geoprocessing techniques, has been adopted in the international sphere (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) . Nevertheless, the introduction of this technology to support the action planning and decision making of health managers and workers is still restricted (18) .In Brazil, a series of studies was undertaken that considered the incidence of the disease and undoubtedly contributed to a better understanding of its dynamics in distinct territories (19) (20) (21) (22) (23) (24) (25) (26) (27) (28) ...

Detection of risk clusters for deaths due to tuberculosis specifically in areas of southern Brazil where the disease was supposedly a non-problem

“…Mortality due to TB is defined as a socially determined event, marked mainly by social inequalities related to income, schooling, housing conditions, labour conditions, the weakness of health services (delay in diagnosis, poor diagnosis and treatment) and the absence of social politics and social protection. The risk of deaths is influenced by these factors, which range between areas in a same city, county or country [5, 6], therefore measuring the spatial risk to which given communities are exposed can contribute to the guidance of public policies and strategic actions [7].…”

“…On the contrary, it is very dynamic and varies between the regions according to the availability of resources in terms of health, social investment, urbanisation, immigration, and modes of social organisation; therefore, the risk of disease and its impact (fatality) are influenced by these social dynamics [5]. The literature indicates that, in certain territories, deaths from TB are more prevalent in areas with social problems and a lack of assistance, however, there are few studies that show this, which is important for addressing the problem [6]. Therefore, measuring the spatial risk to which given communities are exposed can contribute to the guidance of public policies and the adoption of directed and focused health measures.…”

Os determinantes da mortalidade por Tuberculose e TB-HIV no Sul do Brasil: Da abordagem espacial à análise de sobrevida

“…Ribeirão Preto-SP, 2016. Dentre os artigos que utilizaram análise espacial, a análise para detecção de aglomerados de risco foi utilizada por seis autores (ARCOVERDE et al, 2018;SANTOS et al, 2018;BERRA et al, 2017;SANTOS-NETO, et al, 2015;ALVAREZ-HERNANDEZ et al, 2010;HOULIHAN et al, 2010).…”

Como as variações espaciais das iniquidades sociais afetam as mortes por tuberculose? Um estudo com aplicação do Geographically Weighted Regression model em Manaus

“…Manaus/Amazonas, Brasil (2006Brasil ( a 2015 Modelo GWR e seus parâmetros betas: a) Taxa de analfabetismo da população de 18 anos ou mais de idade; b) Proporção de pobres; c) Percentual da renda total apropriada pelos 20% da população com menor renda domiciliar per capita; d) Taxa de desocupação da população de 18 anos ou mais de idade. Manaus/Amazonas, Brasil (2006Brasil ( a 2015 -NETO et al, 2014;SANTOS-NETO et al, 2015;YAMAMURA et al, 2015;BERRA et al, 2017;YAMAMURA et al, 2017;ALVES FILHO et al, 2017;QUEIROZ et al, 2018) Outros estudos empregaram a técnica de varredura na análise espacial e detectaram áreas de alto risco de óbitos por TB pulmonar (SANTOS-NETO et al, 2015;BERRA et al, 2017). Também foi utilizada a análise bivariada, assim como a análise de densidade de pontos, definida com a estimativa de Kernel (SANTOS-NETO et al, 2018;YAMAMURA et al, 2015;QUEIROZ, 2018).…”

“…Santo-Neto et al (2015),Yamamura et al (2015),Berra et al (2017),Queiroz et al (2018),Santos-Neto et al (2014) apontam a importância do conhecimento das áreas de alto risco e vulneráveis para a ocorrência dos óbitos, uma vez que pode contribuir para a definição de estratégias e intervenções em saúde para a eliminação da doença.Na revisão, pôde-se observar que os trabalhos começaram a ser publicados a partir de 2011, talvez por forte influência e indução da OMS, que já demonstrava a importância de se investigar o tema por meio dos seus boletins e relatórios. É válido mencionar que Mota et al (2003) já referiam a pertinência do uso de algumas metodologias que incorporassem a dimensão social e o contexto ambiental.…”