The geographical distribution and socioeconomic risk factors of COVID-19, tuberculosis and leprosy in Fortaleza, Brazil

BACKGROUND

Fortaleza (Brazil) is high endemic for coronavirus disease 2019 (COVID-19), tuberculosis (TB) and leprosy. These three diseases share respiratory droplets through coughing or sneezing as the main mode of transmission but differ in incubation time, with COVID-19 having a short and leprosy a long incubation time. Consequently, contacts of a patient are at higher risk of infection and developing these diseases. There might be scope for combined preventive measures, but a better understanding of the geographical distribution and relevant socioeconomic risk factors of the three diseases is needed first. This study aims to describe the geographic distribution of COVID-19, TB and leprosy incidence and to identify common socioeconomic risk factors.

METHODS

The total number of new cases of COVID-19, TB and leprosy, as well as socioeconomic and demographic variables, were retrieved from official registers. The geographical distribution of COVID-19, TB and leprosy rates per neighbourhood was visualised in Quantum GIS, and spatial autocorrelation was measured with Moran's I in GeoDa. A spatial regression model was applied to understand the association between COVID-19, TB, leprosy rates, and socioeconomic factors.

RESULTS

COVID-19 and TB showed a more homogenous distribution, whereas leprosy is located more in the south and west of Fortaleza. One neighbourhood (Pedras) in the southeast was identified as high endemic for all three diseases. Literacy was a socioeconomic risk factor for all three diseases: a high literacy rate increases the risk of COVID-19, and a low literacy rate (i.e., illiteracy) increases the risk of TB and leprosy. In addition, high income was associated with COVID-19, while low income with TB.

CONCLUSIONS

Despite the similar mode of transmission, COVID-19, TB and leprosy show a different distribution of cases in Fortaleza. In addition, associated risk factors are related to wealth in COVID-19 and to poverty in TB and leprosy. These findings may support policymakers in developing (partially combined) primary and secondary prevention considering the efficient use of resources.

Spatiotemporal heterogeneity and its determinants of COVID-19 transmission in typical labor export provinces of China

Background

Previous studies have indicated that the risk of infectious disease spread is greatest in locations where a population has massive and convenient access to the epicenter of an outbreak. However, the spatiotemporal variations and risk determinants of COVID-19 in typical labor export regions of China remain unclear. Understanding the geographical distribution of the disease and the socio-economic factors affecting its transmission is critical for disease prevention and control.

Methods

A total of 2152 COVID-19 cases were reported from January 21 to February 24, 2020 across the 34 cities in Henan and Anhui. A Bayesian spatiotemporal hierarchy model was used to detect the spatiotemporal variations of the risk posed by COVID-19, and the GeoDetector q statistic was used to evaluate the determinant power of the potential influence factors.

Results

The risk posed by COVID-19 showed geographical spatiotemporal heterogeneity. Temporally, there was an outbreak period and control period. Spatially, there were high-risk regions and low-risk regions. The high-risk regions were mainly in the southwest areas adjacent to Hubei and cities that served as economic and traffic hubs, while the low-risk regions were mainly in western Henan and eastern Anhui, far away from the epicenter. The accessibility, local economic conditions, and medical infrastructure of Wuhan in Hubei province all played an important role in the spatiotemporal heterogeneity of COVID-19 transmission. The results indicated that the q statistics of the per capita GDP and the proportion of primary industry GDP were 0.47 and 0.47, respectively. The q statistic of the population flow from Wuhan was 0.33. In particular, the results showed that the q statistics for the interaction effects between population density and urbanization, population flow from Wuhan, per capita GDP, and the number of doctors were all greater than 0.8.

Conclusions

COVID-19 showed significant spatiotemporal heterogeneity in the labor export regions of China. The high-risk regions were mainly located in areas adjacent to the epicenter as well as in big cities that served as traffic hubs. Population access to the epicenter, as well as local economic and medical conditions, played an important role in the interactive effects of the disease transmission.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-021-05926-x.

Factors associated with stunting and wasting in children under 2 years in Bangladesh

Child undernutrition has been a major concern for Bangladesh as it is amongst the highest stunting and wasting prevalent countries in the world. The objective of our study was to explore the socioeconomic determinants of stunting and wasting in children under two years. This study explored nationally representative sample of 7,230 children ranging in age from 0 to <24 months using two separate binary logistic regression models to determine the risk factors associated with child stunting and wasting. Our study estimated approximately 33 percent children to be stunted and 11 percent to be wasted. Our analysis found that, 12 to <24 months old children's height-for-age-z-score and weight-for-height-z-score deteriorated in comparison to those of below 6 months. Female children had significantly lower odds of stunting and wasting compared with male children. Study revealed that children from wealthier families were at lower risk of being stunted and wasted compared to children from poorer households. Parental education was determined as a significant predictor of stunting. Children who lived in Sylhet division were 1.26 times more likely to be stunted than the children of Dhaka division [OR = 1.26; 95% CI: 1.02-1.55]. Our study revealed age, gender, geographic distribution, and household's position in wealth index as common determinants of child stunting and wasting in Bangladesh. While parental education was significant predictor for child stunting, type of toilet facility was found as statistically significant determinant of child wasting in children of less than two years age.

Clusters of non-dietary obesogenic behaviors among adolescents in Brazil: a latent profile analysis

OBJECTIVES

To identify patterns of non-dietary obesogenic behaviors, and social and environmental factors associated with overweight and obesity (OWOB).

METHODS

A representative sample (n = 5520) of high school students (55.4% girls, 16.3 ± 1.0 years) from Pernambuco State, Brazil. Latent profile analyses were performed using self-reported daily sleep duration, television use, computer use, videogame use, seated time during the week and weekend days, physical activity, and active commuting to school during the week. Social and environmental factors and body mass index were included to identify classes. Multinomial analysis explored differences in social, environmental factors, and BMI by classes.

RESULTS

Five patterns were identified [Computer users (C1), Short sleepers (C2), Typical behaviors (C3), Techno-active-gamers (C4), and Lower screen engagement (C5)]. Three groups (C1, C3 and C4) included students from better social conditions and a more urbanized environments. The prevalence of OWOB was higher in C1 (34.5%; 95% CI 31.1-38.0) and in C2 (29.7%; 95% CI 26.1-33.5) compared to C5 (23.3% 95% CI 21.3-25.3).

CONCLUSIONS

In one of the poorest regions of Brazil, different groups of social/environmental factors and behavior patterns emerged associated with OWOB.

Guideline-concordant Care Improves Overall Survival for Locally Advanced Non-Small-cell Lung Carcinoma Patients: A National Cancer Database Analysis

BACKGROUND

Current evidence-based guideline-concordant care (GCC) for locally advanced non-small-cell lung cancer (NSCLC) patients with good performance status is concurrent chemoradiation. In this study we evaluated factors associated with lack of GCC and its effects on overall survival (OS).

PATIENTS AND METHODS

Unresectable stage III NSCLC patients, diagnosed from 2005 to 2013 with a Charlson-Deyo score of 0, were identified from the National Cancer Database. Primary outcomes were receipt of GCC, defined as concurrent chemoradiation (thoracic radiotherapy, starting within 2 weeks of chemotherapy, to at least 60 Gy), and OS. Multivariable logistic regression modeling identified variables associated with non-GCC. Cox proportional hazard modeling was used to examine OS.

RESULTS

Twenty-three percent of patients (n = 10,476) received GCC. Uninsured patients were more likely to receive non-GCC (odds ratio [OR], 1.54; P < .001) compared with privately insured patients. Other groups with greater odds of receiving non-GCC included: patients treated in the western, southern, or northeastern United States (ORs, 1.39, 1.37, and 1.19, respectively; all Ps < .001) compared with the Midwest; adenocarcinoma histology (OR, 1.48; P < .001) compared with squamous cell carcinoma; and women (OR, 1.08; P = .002). Those who received non-GCC had higher death rates compared with those who received GCC (hazard ratio [HR], 1.42; P < .001). The uninsured (HR, 1.53; P < .001), patients treated in the western, southern, or northeastern United States (HRs, 1.56, 1.41, and 1.34, respectively; P < .001), adenocarcinomas (HR, 1.39; P < .001), and women (HR, 1.44; P < .001) also all had lower OS for non-GCC versus GCC.

CONCLUSION

Socioeconomic factors, including lack of insurance and geography, are associated with non-GCC. Patient- and disease-specific factors, including increasing adenocarcinoma histology and sex, are also associated with non-GCC. Non-GCC diminishes OS.

The role of neighborhood characteristics and the built environment in understanding racial/ethnic disparities in childhood obesity

BACKGROUND

Childhood obesity prevalence remains high and racial/ethnic disparities may be widening. Studies have examined the role of health behavioral differences. Less is known regarding neighborhood and built environment mediators of disparities. The objective of this study was to examine the extent to which racial/ethnic disparities in elevated child body mass index (BMI) are explained by neighborhood socioeconomic status (SES) and built environment.

METHODS

We collected and analyzed race/ethnicity, BMI, and geocoded address from electronic health records of 44,810 children 4 to 18years-old seen at 14 Massachusetts pediatric practices in 2011-2012. Main outcomes were BMI z-score and BMI z-score change over time. We used multivariable linear regression to examine associations between race/ethnicity and BMI z-score outcomes, sequentially adjusting for neighborhood SES and the food and physical activity environment.

RESULTS

Among 44,810 children, 13.3% were black, 5.7% Hispanic, and 65.2% white. Compared to white children, BMI z-scores were higher among black (0.43units [95% CI: 0.40-0.45]) and Hispanic (0.38 [0.34-0.42]) children; black (0.06 [0.04-0.08]), but not Hispanic, children also had greater increases in BMI z-score over time. Adjusting for neighborhood SES substantially attenuated BMI z-score differences among black (0.30 [0.27-0.34]) and Hispanic children (0.28 [0.23-0.32]), while adjustment for food and physical activity environments attenuated the differences but to a lesser extent than neighborhood SES.

CONCLUSIONS

Neighborhood SES and the built environment may be important drivers of childhood obesity disparities. To accelerate progress in reducing obesity disparities, interventions must be tailored to the neighborhood contexts in which families live.