Distribution and spatial autocorrelation of the hospitalizations for cardiovascular diseases in adults in Brazil

Retrospective analysis of spatiotemporal variation of scrub typhus in Yunnan Province, 2006-2022

BACKGROUND

Scrub typhus is a life-threatening zoonotic infection. In recent years, the endemic areas of scrub typhus have been continuously expanding, and the incidence rate has been increasing. However, it remains a globally neglected disease. Yunnan Province is a major infected area, and the study of spatiotemporal and seasonal variation scrub typhus in this region is crucial for the prevention and control of the disease.

METHODS/RESULTS

We collected surveillance data on scrub typhus cases in Yunnan Province from 2006 to 2022. Using methods such as spatial trend analysis, Moran's I, and retrospective temporal scan statistics, the spatial and seasonal changes of scrub typhus were analyzed. The study period recorded 71,068 reported cases of scrub typhus in Yunnan Province, with the annual incidence rate sharply increasing (P<0.001). Approximately 93.38% of cases are concentrated in June to November (P = 0.001). Nearly 98.0% of counties were affected. The center of gravity of incidence migrates in a south and west direction. The incidence of scrub typhus was positively correlated spatially, and the spatial clustering distribution was significant. The most likely spatial cluster of cases (relative risk = 14.09, P<0.001) was distributed in Lincang, Dehong, Baoshan, Banna, and Puer. Significant positive correlations between the number of scrub typhus cases and average temperature, precipitation and relative humidity.

CONCLUSIONS

In Yunnan Province, scrub typhus is widely transmitted, with an increasing incidence, and it exhibits distinct seasonal characteristics (from June to November). The center of gravity of incidence has shifted to the south and west, with higher incidence rates observed in border regions. The risk clustering regions encompass all border prefectures. This pattern is significantly correlated with climatic factors such as average temperature, precipitation, and relative humidity. The relevant departments should strengthen the monitoring of scrub typhus, formulate prevention and control strategies, and provide health education to local residents.

Temporal-spatial analysis of mortality from cardiovascular diseases in the State of Ceará, Brazil, between 2009-2019

OBJECTIVE

To analyze the spatial distribution of mortality from cardiovascular diseases in the municipalities of the state of Ceará, Brazil, between 2009-2019.

METHODS

This is an ecological study with a spatial focus on the state of Ceará, considering the period from 2009 to 2019. Death data from the Brazilian Mortality Information System and population data from the Brazilian Institute of Geography and Statistics were used to calculate crude and standardized mortality rates from cardiovascular diseases. Temporal analysis was carried out using the Joinpoint Regression Program 4.9.0 software and spatial analysis of the municipalities' average mortality. The values were smoothed by the local empirical Bayesian method using QGIS 3.16. For spatial clusters, the Global and Local Moran Index was used through Moran Map and LISA Map, with analyses carried out in TerraView 4.2.2.

RESULTS

A total of 132,145 deaths from cardiovascular diseases were recorded in the period, with an average increase of 3% per year. Higher mortality rates were observed in men, people aged ≥80 years, mixed-race ethnicity/skin color, married, and with lower level of education. There was the formation of clusters of municipalities with high mortality rates in the regions of Vale do Jaguaribe, Sertão Central, Centro Sul, Sertão dos Inhamuns and Serra da Ibiapaba.

CONCLUSION

This study identified municipalities with high mortality and exposed the need for strategies aligned with the reality and particularities of these locations.

Health Promotion Programs Can Mitigate Public Spending on Hospitalizations for Stroke: An Econometric Analysis of the Health Gym Program in the State of Pernambuco, Brazil

Health promotion programs can reduce morbidity and mortality from chronic diseases, as well as public spending on health. The current study aims to evaluate the effects of the Health Gym Program on expenditures on hospitalizations for stroke in the state of Pernambuco, Brazil. This public policy impact assessment used an econometric model that combines the difference-in-difference estimator with propensity score matching. Data referring to the health, demographic, and socioeconomic characteristics of the 185 municipalities in Pernambuco were collected for the period from 2007 to 2019. Validation tests were carried out of the empirical strategy, the estimation of models with fixed effects for multiple periods and validation post-tests, and robustness of the results. In total, US$ 52,141,798.71 was spent on hospitalizations for stroke, corresponding to 4.42% of the expenses on hospitalizations for all causes over the period studied. Municipalities that implemented the Health Gym Program spent 17.85% less on hospitalizations for stroke than municipalities that did not. The findings of this study indicate that the Health Gym Program was effective in reducing expenses with hospitalizations for stroke and that its implementation has the potential to reduce expenses related to rehabilitation, sick leave, and early retirement.