Using geo-spatial analysis for assessing the Risk of Hospital Admissions due to Community-Acquired Pneumonia in Children and its association with socially vulnerable areas (Brazil)

Abstract

Background: The concentration of child morbidity and mortality due to pneumonia in developing countries reflects the social inequities, which lead to greater exposure to risk factors and make access to prevention, diagnosis and treatment of the disease more difficult. This study aimed to map and assess the spatial risk for hospitalization due to Community-Acquired Pneumonia in children under 5 years of age and its association with vulnerable areas. Methods: Ecological study, carried out in the city of Ribeirão Preto, state of São Paulo, Brazil. The study population consisted of hospitalized children under the age of five, diagnosed with community-acquired pneumonia, in Ribeirão Preto-São Paulo-Brazil, from 2012 to 2013. Data were collected in different databases, by a trained team, between March 2012 and August 2013 and from the 2010 Demographic Census of the Brazilian Institute of Geography and Statistics. The 956 urban census tracts were considered as the units of analysis. The incidence of cases per 10,000 inhabitants was calculated by census tracts during the study period. For the identification of the spatial risk clusters, the Kernel density estimator and the Getis-Ord Gi* technique were measured from the Radius of the distance of 7,589km, with p<.01, found using the Incremental Spatial Autocorrelation tool. Generalized additive models were used to verify the association between areas with social vulnerability and the occurrence of childhood pneumonia. Results: The study included 265 children under the age of five, hospitalized due to community-acquired pneumonia. A concentration of cases was identified in the regions with greater social vulnerability (low income, poor housing conditions and homelessness), as well as a lower occurrence of cases in the most developed and economically privileged area of the city. The majority of the children lived in territories served by traditional primary healthcare units, in which the health surveillance and family and community focus are limited. Conclusions: The results contribute to the comprehension of the social factors involved in child hospitalization due to pneumonia, based on the analysis of the spatial distribution, and address the interface with individual and institutional factors.