Spatial analysis of tuberculosis cure in primary care in Rio de Janeiro, Brazil

Social determinants of respiratory health from birth: still of concern in the 21st century?

Respiratory symptoms are ubiquitous in children and, even though they may be the harbinger of poor long-term outcomes, are often trivialised. Adverse exposures pre-conception, antenatally and in early childhood have lifetime impacts on respiratory health. For the most part, lung function tracks from the pre-school years at least into late middle age, and airflow obstruction is associated not merely with poor respiratory outcomes but also early all-cause morbidity and mortality. Much would be preventable if social determinants of adverse outcomes were to be addressed. This review presents the perspectives of paediatricians from many different contexts, both high and low income, including Europe, the Americas, Australasia, India, Africa and China. It should be noted that there are islands of poverty within even the highest income settings and, conversely, opulent areas in even the most deprived countries. The heaviest burden of any adverse effects falls on those of the lowest socioeconomic status. Themes include passive exposure to tobacco smoke and indoor and outdoor pollution, across the entire developmental course, and lack of access even to simple affordable medications, let alone the new biologicals. Commonly, disease outcomes are worse in resource-poor areas. Both within and between countries there are avoidable gross disparities in outcomes. Climate change is also bearing down hardest on the poorest children. This review highlights the need for vigorous advocacy for children to improve lifelong health. It also highlights that there are ongoing culturally sensitive interventions to address social determinants of disease which are already benefiting children.

Excess deaths among adults in the state of Santa Catarina: an ecological study during the COVID-19 pandemic, Brazil, 2020-2021

OBJECTIVE

to estimate excess deaths during the COVID-19 pandemic in the state of Santa Catarina and its macro-regions, Brazil, 2020-2021.

METHODS

this was an ecological study, using data from the Mortality Information System; excess deaths in adults were calculated by the difference between the observed number of deaths and expected number of deaths, taking into account the average of deaths that occurred between 2015 and 2019; the variables "macro-region of residence", "quarter", "month", "sex" and "age group" were analyzed; data were analyzed in a descriptive manner.

RESULTS

a total of 6,315 excess deaths in 2020 and 17,391 in 2021, mostly in males (57.4%) and those aged 60 years and older (74.0%); macro-regions and periods with the greatest excess deaths were those in which there were most deaths due to COVID-19; the greatest excess deaths occurred in March 2021 (n = 4,207), with a progressive decrease until the end of the year.

CONCLUSION

there were excess deaths in the state of Santa Catarina and in all its macro-regions during the COVID-19 pandemic.

Distribution of tuberculosis cases in the state of Paraná: an ecological study, Brazil, 2018-2021

OBJECTIVE

to analyze the distribution of tuberculosis cases in the state of Paraná, Brazil, between 2018 and 2021.

METHODS

this was an ecological study using secondary data obtained from compulsory notifications; detection rates per 100,000 inhabitants were described according to health regions in the state; percentage changes between 2018-2019 and 2020-2021 were calculated.

RESULTS

a total of 7,099 cases were registered. The highest rates were observed in the health regions of Paranaguá (52.4/100,000 in 2018-2019; 38.2/100,000 in 2020-2021) and Foz do Iguaçu (34.4/100,000 in 2018-2019; 20.5/100,000 in 2020-2021), and the lowest rates in Irati (6.3/100,000 in 2018-2019; 8.8/100,000 in 2020-2021) and Francisco Beltrão (8.5/100,000 in 2018-2019; 7.6/100,000 in 2020-2021); in 2020-2021, it could be seen a decrease in percentage changes in 18 health regions, while there was an increase in four of them, especially Foz do Iguaçu (-40.5%) and Cianorte (+53.6%).

CONCLUSION

high rates were found in the coastal and triple border regions; and there was a decline in detection rates in the pandemic period.

Spatial age-period-cohort analysis of hepatitis B risk in Xinjiang from 2006 to 2019

Objective

The objective of this study was to investigate the spatio-temporal distribution and epidemiological characteristics of hepatitis B in 96 districts and counties of Xinjiang and to give useful information for hepatitis B prevention and treatment.

Methods

Based on the incidence data of hepatitis B in 96 districts and counties of Xinjiang from 2006 to 2019, the global trend analysis method was used to characterize the spatial variability of the disease, and the spatial autocorrelation and spatio-temporal aggregation analysis were used to explore the spatial clustering of hepatitis B and to identify high-risk areas and periods. The Integrated Nested Laplace Approximation (INLA)-based spatial age-period-cohort model was established to further explore the influence of age, period, birth queue effect, and spatial distribution on the incidence risk of hepatitis B, and sum-to-zero constraint was adopted to avoid the issue of model unrecognition.

Results

The risk of hepatitis B in Xinjiang is increasing from west to east and from north to south, with spatial heterogeneity and spatio-temporal scanning statistics yielding five clustering areas. The spatial age-period-cohort model showed two peaks in the average risk of hepatitis B, at [25,30) years old and [50,55) years old, respectively. The mean risk of hepatitis B incidence fluctuated up and down around 1 with time, and the average risk of disease by birth cohort displayed an increasing-decreasing-stabilizing trend. Taking age, period, and cohort effect into consideration, it was found that the areas with a high risk of hepatitis B are Tianshan District, Xinshi District, Shuimogou District, Changji City, Aksu City, Kashi City, Korla City, Qiemo County and Yopurga County in Xinjiang. According to the spatio-temporal effect item, it was found that there are unobserved variables affecting the incidence of hepatitis B in some districts and counties of Xinjiang.

Conclusion

The spatio-temporal characteristics of hepatitis B and the high-risk population needed to be taken into attention. It is suggested that the relevant disease prevention and control centers should strengthen the prevention and control of hepatitis B among young people while paying attention to middle-aged and older adult people, and strengthening the prevention and monitoring of high-risk areas.

Geoespacialização da tuberculose e os programas de transferência de renda entre indígenas em território endêmico

RESUMO Objetivo: Analisar o padrão espacial de tuberculose em indígenas do Pará e sua correlação com transferência de renda. Métodos: Estudo ecológico, com 340 casos notificados em indígenas no Pará/Brasil, no período 2016-2020. Realizou-se análise descritiva e cálculo das taxas de incidência com suavização pelo método bayesiano empírico local. Fez-se autocorrelação das taxas com dados de transferência de renda pelo Moran Global, p<0,05. Resultados: As mesorregiões Marajó e Metropolitana de Belém apresentaram as taxas de tuberculose mais elevadas e reduzido número de pessoas beneficiadas com transferência de renda (correlação alto-baixo). No Sudoeste, identificaram se taxas elevadas e número significativo de pessoas beneficiadas com os auxílios financeiros (correlação alto alto), I=0,399, p=0,027. Conclusões: A autocorrelação espacial entre tuberculose e acesso a programas de transferência de renda constitui importante subsídio para formulação de políticas de proteção social, podendo impactar as ações de controle da doença nos territórios indígenas, valorizando a heterogeneidade epidemiológica identificada nas mesorregiões.

Geospatialization of tuberculosis and income transfer programs among Indigenous peoples in an endemic territory

OBJECTIVE

To analyze the spatial pattern of tuberculosis in Indigenous peoples from the State of Pará and its correlation with income transfer.

METHODS

Ecological study, with 340 cases reported in Indigenous peoples in the State of Pará, Brazil, in the period 2016-2020. The study performed a descriptive analysis and calculation of incidence rates with smoothing by the local empirical Bayesian method. The Global Moran index assessed the autocorrelation of the rates with income transfer data, p<0,05.

RESULTS

The Marajó and metropolitan mesoregions of Belém had the highest tuberculosis rates, and a reduced number of people benefited from income transfer (high-low correlation). The study identified high rates, and a significant number of people benefited from financial aid (high correlation high), I=0.399, p=0.027 in the Southwest.

CONCLUSIONS

The spatial autocorrelation between tuberculosis and access to income transfer programs constitutes a relevant subsidy for the formulation of social protection policies and may impact the disease control actions in Indigenous territories, valuing the epidemiological heterogeneity identified in the mesoregions.

Spatial Epidemiological Analysis of Keshan Disease in China

Objectives:

Few researchers have studied the national prevalence of Keshan disease (KD) in China using spatial epidemiological methods. This study aimed to provide geographically precise and visualized evidence for the strategies for KD prevention and control.

Methods:

We surveyed and analyzed 237,000 people in 280 out of 328 KD-endemic counties (85.4%) in mainland China using a design of key investigation based on case-searching in 2015–2016. ArcGIS version 9.0 was used for spatial autocorrelation analysis, spatial interpolation analysis and spatial regression analysis.

Results:

Global autocorrelation analysis showed that global clustering of latent Keshan disease (LKD) prevalence was noted (Moran’s I = 0.22, Z = 7.06, and P < 0.0001), no global clustering of chronic Keshan disease (CKD) prevalence (Moran’s I = 0.03, Z = 1.10, and P = 0.27) was observed. Spatial regression analysis showed that LKD prevalence was negatively correlated with per capita disposable income (t = –4.36, P < 0.0001). Local autocorrelation analysis at the county level effectively identified the cluster areas of LKD prevalence in the provinces of Shaanxi, Gansu, Shanxi, Inner Mongolia, and Jilin. The high-high cluster areas should be given priority for precision prevention and control of Keshan disease.

Conclusions:

This spatial epidemiological study revealed that LKD prevention and control should be strengthened in areas with high values of clustering. Our findings provided spatially, geographically precise and visualized evidence for prioritizing KD prevention and control.

Risk-prone territories for spreading tuberculosis, temporal trends and their determinants in a high burden city from São Paulo State, Brazil

Objectives

To identify risk-prone areas for the spread of tuberculosis, analyze spatial variation and temporal trends of the disease in these areas and identify their determinants in a high burden city.

Methods

An ecological study was carried out in Ribeirão Preto, São Paulo, Brazil. The population was composed of pulmonary tuberculosis cases reported in the Tuberculosis Patient Control System between 2006 and 2017. Seasonal Trend Decomposition using the Loess decomposition method was used. Spatial and spatiotemporal scanning statistics were applied to identify risk areas. Spatial Variation in Temporal Trends (SVTT) was used to detect risk-prone territories with changes in the temporal trend. Finally, Pearson's Chi-square test was performed to identify factors associated with the epidemiological situation in the municipality.

Results

Between 2006 and 2017, 1760 cases of pulmonary tuberculosis were reported in the municipality. With spatial scanning, four groups of clusters were identified with relative risks (RR) from 0.19 to 0.52, 1.73, 2.07, and 2.68 to 2.72. With the space–time scan, four clusters were also identified with RR of 0.13 (2008–2013), 1.94 (2010–2015), 2.34 (2006 to 2011), and 2.84 (2014–2017). With the SVTT, a cluster was identified with RR 0.11, an internal time trend of growth (+ 0.09%/year), and an external time trend of decrease (− 0.06%/year). Finally, three risk factors and three protective factors that are associated with the epidemiological situation in the municipality were identified, being: race/brown color (OR: 1.26), without education (OR: 1.71), retired (OR: 1.35), 15 years or more of study (OR: 0.73), not having HIV (OR: 0.55) and not having diabetes (OR: 0.35).

Conclusion

The importance of using spatial analysis tools in identifying areas that should be prioritized for TB control is highlighted, and greater attention is necessary for individuals who fit the profile indicated as “at risk” for the disease.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07500-5.