Temporal trend in the incidence of tuberculosis-HIV coinfection in Brazil, by macro-region, Federative Unit, sex and age group, 2010-2021

OBJECTIVE

To analyze the temporal trend in the incidence of tuberculosis-HIV coinfection in Brazil, by macro-region, Federative Unit, sex and age group, from 2010 to 2021.

METHODS

This was a time series study using surveillance data to estimate average annual percentage changes (AAPC), and 95% confidence intervals (95%CI) via joinpoint regression.

RESULTS

122,211 cases of tuberculosis-HIV coinfection were analyzed; a falling trend was identified for Brazil as a whole (AAPC = -4.3; 95%CI -5.1;-3.7), and in the country's Southern (AAPC = -6.2; 95%CI -6.9;-5.5) and Southeast (AAPC = -4.6; 95%CI -5.6;-3.8) regions, even more so during the COVID-19 pandemic (2020-2021); the greatest falling trend was seen in Santa Catarina (AAPC = -9.3; 95%CI -10.1;-8.5), while the greatest rising trend was found in Tocantins (AAPC = 4.1; 95%CI 0.1;8.6); there was a rising trend among males, especially in Sergipe (AAPC = 3.9; 95%CI 0.4;7.9), and those aged 18 to 34 years, especially in Amapá (AAPC = 7.9; 95%CI 5.1;11.5).

CONCLUSION

The burden and trends of tuberculosis-HIV coinfection were geographically and demographically disparate.

Characterization of cases and epidemiological and operational indicators of leprosy: analysis of time series and spatial distribution, Piauí state, Brazil, 2007-2021

OBJECTIVE

To analyze epidemiological characteristics, temporal trends and spatial distribution of leprosy cases and indicators in the state of Piauí, 2007-2021.

METHODS

This was an ecological time-series study using data from the Notifiable Health Conditions Information System, describing the spatial distribution and the temporal trend of leprosy using Prais-Winsten regression.

RESULTS

A total of 17,075 new cases of leprosy were reported. There was a falling trend in the overall detection rate [annual percentage change (APC) = -6.3; 95%CI -8.1;-4.5)], detection in children under 15 years of age (APC = -8,6; 95%CI -12,7;-4,3) and detection of cases with grade 2 physical disability (APC = -4,4; 95%CI -7,0;-1,8). There was a rising trend in the proportion of multibacillary cases. Spatial distribution of the average detection rate identified hyperendemic areas in the Carnaubais, Entre Rios, Vale dos Rios Piauí e Itaueiras regions.

CONCLUSION

High leprosy detection rates were found, despite the falling trend of indicators, except the proportion of multibacillary cases.

MAIN RESULTS

Between 2007 and 2021, Piauí showed an improving trend in all indicators analyzed, except the proportion of new multibacillary cases. Spatial distribution identified hyperendemic areas in different regions of the state.

IMPLICATIONS FOR SERVICES

This study provides health services with a broad overview of the epidemiological situation of leprosy in Piauí, with evidence of the populations and locations most affected by the disease, whereby public authorities need to reinforce the promotion of health actions.

PERSPECTIVES

It is expected that actions to prevent and control the disease will be adopted, such as offering early diagnosis, ensuring correct treatment and implementing measures to prevent physical disabilities.

Time trend and costs of hospitalizations with diabetes mellitus as main diagnosis in the Brazilian National Health System, 2011 to 2019

OBJECTIVE

To analyze the diabetes mellitus (DM) temporal trend and hospitalization costs in Brazil, by region, Federative Units (FUs) and population characteristics, from 2011 to 2019.

METHODS

This was an ecological study with data from the Hospital Information System, analyzing the annual trend in hospitalization rates for DM according to sex, age, race/skin color and region/FU by Prais-Winsten generalized linear regression.

RESULTS

A total of 1,239,574 DM hospitalizations were recorded in the country and the hospitalization rates was 6.77/10,000 inhabitants in the period. The DM hospitalization rates trend was falling for both sexes and in most regions, while it was rising in the younger population and for length of stay (average 6.17 days). Total expenditure was US$ 420,692.23 and it showed a rising trend.

CONCLUSION

The temporal trend of hospitalization rates due to DM was falling, with differences according to region/FU and age group. Average length of stay and expenditure showed a rising trend.

MAIN RESULTS

From 2011 to 2019, the diabetes mellitus hospitalization rate was 6.77 per 10,000 inhabitants, with a falling trend. Total expenditure was US$420,692.23 and it showed a rising trend.

IMPLICATIONS FOR SERVICES

The study warns of the increase in child and adolescent hospitalizations, which indicates the need to invest in preventive actions and early diagnosis.

PERSPECTIVES

The increase in length of hospital stay and related costs indicates a worrying scenario for the Brazilian National Health System and emphasizes the need to improve access to and quality of care, with a focus on diabetes education, so as to avoid complications and hospitalizations.

Occupational accident indicators among Social Security beneficiaries: temporal trend and magnitude in Brazil and its regions, 2009-2019

OBJECTIVE

To evaluate the temporal trend and magnitude of occupational accident indicators among Social Security beneficiaries in Brazil and its regions from 2009 to 2019.

METHODS

A time series study was conducted on occupational accident indicators in the regions of Brazil, from 2009 to 2019. Data were retrieved from the Statistical Yearbook of Occupational Accidents and the Statistical Yearbook of Social Security. Prais-Winsten generalized linear regression models were used to estimate trends, and annual percentage change and their respective 95% confidence intervals were obtained.

RESULTS

There were 7,253,923 occupational accidents during the study period. The average incidence rate was 16.3 per 1,000 employment relationships, with a decreasing trend (APC = 4.3%; 95%CI -5.63;-3.26).

CONCLUSION

Brazil and its regions showed an overall decreasing trend in indicators representing morbidity burden and the magnitude of occupational accidents.

MAIN RESULTS

In Brazil, despite regional inequalities, there has been a decrease in occupational accident rates reported to Social Security.

IMPLICATIONS FOR SERVICES

The results suggest improvements in working conditions, control and prevention of occupational accidents among these workers and contribute to targeting measures to prevent and control these diseases in the regions with the highest incidence.

PERSPECTIVES

Further research could explore trends according to professional category and economic activity sector, aimed at improving the monitoring of safety conditions and the wellbeing of workers in the regions of Brazil.

Mortality trend due to chronic kidney disease in Brazil: an ecological study

OBJECTIVE

To analyze chronic kidney disease mortality in Brazil according to sex, age group and region of residence, from 2009 to 2020.

METHODS

This was a time series study having deaths as its unit of analysis, based on Mortality Information System data. The mortality rate was standardized using the direct method and the temporal trend was analyzed using the Prais-Winsten method.

RESULTS

There was a rising trend in chronic kidney disease mortality, ranging from 2.82, in 2009, to 3.24 in 2020 (average annual increase 1.29%; 95%CI 0.73;1.85), with a greater increase in males (1.14% per year; 95%CI 0.52;1.76), those aged 75 years and over (2.23% per year; 95%CI 1.87; 2.60) and in the Northern Region (3.86% per year; 95%CI 1.86;5.90) and Northeast Region (3.36% per year; 95%CI 2.24;4.50).

CONCLUSION

Chronic kidney disease mortality showed a rising trend in the period, with sociodemographic disparities.

MAIN RESULTS

A rising mortality trend was found for both sexes, with a greater increase in males, those aged over 75 years and in the North and Northeast regions of Brazil; mortality was highest in the Midwest region throughout the entire period.

IMPLICATIONS FOR SERVICES

The results point to the need to implement public policies with guidelines for addressing chronic kidney disease, focused on strengthening Primary Health Care (PHC).

PERSPECTIVES

Expanding access to health services, health education and integration between PHC, health surveillance and specialized care are strategies that would possibly prove to be efficient in managing this chronic health condition.

[Temporal trend of physical activity in Brazilian adolescents: analysis of the Brazilian National Survey of School Health from 2009 to 2019]

This study aimed to analyze the physical activity trend of Brazilian schoolchildren and the associations with demographic, socioeconomic, and behavioral variables by using the Brazilian National Survey of School Health (PeNSE) in its four editions - 2009, 2012, 2015, and 2019. Data from students (13-17 years old) participating in the four editions of the PeNSE (n = 392,922) were used. We describe the percentage of active, mean, and percentile values of moderate to vigorous intensity physical activity in minutes/week. Poisson's regression was adjusted for gender, age, skin color, goods score, and sedentary behavior (≥ 2 hours/day watching TV and ≥ 3 hours/day sitting time). As a limitation, the PeNSE/2009 sample refers only to the Brazilian capital cities. The percentage of active students decreased from 43.1% in 2009 to 18.2% in 2019. The mean moderate to vigorous intensity physical activity of PeNSE/2009 (mean = 318.4 minutes/week; 95%CI: 313.4-323.4) decreased 50% in 2019. In physical education, the weekly average in moderate to vigorous intensity physical activity of girls is less than 50 minutes and boys is greater than 60 minutes in the four editions of PeNSE, also 22.7% of girls reported (PeNSE/2019) not having taken physical education classes whereas the same thing is reported by 19.7% of boys. Sedentary behavior reduced regarding time watching TV, but sitting time increased by 50.1% (95%CI: 48.9-51.3) and 54% (95%CI: 53.1-54.9) between PeNSE/2009 and PeNSE/2019. As a consequence of the drop in physical activity levels, public policies that promote physical activity are necessary, including increasing physical education classes at school to at least three times a week.

Maternal mortality in Northeast Brazil 2009-2019: spatial distribution, trend and associated factors

OBJECTIVE

To analyze the spatio-temporal pattern of maternal mortality and associated factors in Northeast Brazil, from 2009 to 2019.

METHODS

This was an ecological study using the joinpoint method for temporal analysis and spatial autocorrelation and scan tests to identify clusters; regression models using the ordinary least squares and geographically weighted regression methods were used to identify factors associated with mortality, considering p-value < 0.05.

RESULTS

Maternal mortality decreased by 1.5% (95%CI; -2.5;-0.5) per year (p-value = 0.009); clusters, of deaths were found, mainly in Piauí and Maranhão, the variables associated with the maternal mortality ratio were Gini Index (β = 105.72; p-value < 0.001), municipal human development index (β = 190.91; p-value = 0.001), per capita income (β = -0.08; p-value = 0.001), Firjan Municipal Development Index-Health (β = -51.28; p-value < 0.001), life expectancy at birth (β = -3.50; p-value < 0.001).

CONCLUSION

There was a reduction in mortality in the period studied, with a concentration of deaths, primarily in Piauí and Maranhão; socioeconomic indicators were associated with higher mortality in the region.

MAIN RESULTS

There was a decrease in maternal mortality in Northeast Brazil, from 2009 to 2019. Deaths were mainly concentrated in the states of Piauí and Maranhão. Five socioeconomic indicators were associated with higher mortality in the region.

IMPLICATIONS FOR SERVICES

In order to maintain the trend of falling maternal mortality in Northeast Brazil, the need exists to reduce social inequalities and expand access to health services, especially within the scope of Primary Care.

PERSPECTIVES

Public policies are needed to expand health services in general as well as comprehensive women's health care in the Brazilian National Health System, especially for women living in contexts of greater social vulnerability.

Temporal trend of the dropout rate and vaccination coverage of the triple viral vaccine in Brazil, 2014-2021

MAIN RESULTS

Annual vaccination coverage was below 95% in Brazil. The second dose of the vaccine showed stationary and decreasing trends in the country's Federative Units. The dropout rate varied greatly throughout the study period.

IMPLICATIONS FOR SERVICES

The results found regarding the trends serve to inform and point to the urgency of planning actions aimed at improving coverage of the triple viral vaccine nationally in Brazil.

PERSPECTIVES

Investments in enhanced training of epidemiological surveillance professionals and enhanced computerized systems are necessary, with a view to continuous monitoring, to support actions to promote better and timely vaccine coverage.

OBJECTIVE

to analyze the temporal trend of coverage and dropout rate for triple viral vaccine in Brazil, according to the country's Federative Units and Macro-Regions, between 2014 and 2021.

METHODS

this was an ecological time series study, using data from the National Immunization Program Information System and the Live Birth Information System; joinpoint regression models were used.

RESULTS

in Brazil as a whole annual vaccination coverage was below 95% and ranged from 92.3% (2015) to 54.4% (2021); the second dose of the vaccine showed a decreasing temporal trend in the period (average change over the period = -5.8; 95%CI -10.5;-0.8); the temporal trends were stationary and decreasing in the country's Federative Units; the dropout rate ranged from 22.2% (2014) to 37.4% (2021).

CONCLUSION

there was a downward trend in vaccination coverage and an increase in the dropout rate in Brazil as a whole and in the country's Federative Units.

Temporal trend of mortality from infectious respiratory diseases in childhood in Minas Gerais, Brazil, 2000-2020

MAIN RESULTS

From 2000 to 2020, there was a downward trend in mortality due to infectious respiratory disease in children living in Minas Gerais - even in 2020, the year of the COVID-19 pandemic.

IMPLICATIONS FOR SERVICES

There was a reduction in child deaths due to respiratory infections; health services should be alerted as to the considerable presence of ill-defined or inconclusive codes (garbage codes) on death certificates.

PERSPECTIVES

It is necessary to maintain the effectiveness of health actions among the mother and child population and to improve the records held on the Mortality Information System, in order to enable better monitoring of mortality as well as to enable analytical studies to be conducted.

OBJECTIVE

to analyze temporal trends in mortality due to infectious respiratory disease in children under 12 years old in Minas Gerais, Brazil, from 2000 to 2020.

METHODS

this was an ecological study using data on infectious respiratory disease in children under 12 years old registered on the Mortality Information System; the variables studied were etiological agent, anatomical site of infection and sex; trends were analyzed by joinpoint regression.

RESULTS

of the 4,688 registered deaths, the etiological agent of the disease was unspecified for 84.5% of them, and 88% were due to lower respiratory tract infections; there was a decreasing trend in deaths and in the proportion of deaths due to unspecified etiologic agents; in 2020, there was an increase in deaths with viral etiology and systemic involvement.

CONCLUSION

in addition to the change in the etiologic profile, there was a reduction in mortality due to infectious respiratory diseases in children, even considering 2020, the year of the COVID-19 pandemic.

Maternal mortality in adolescents and young adults: temporal trend and correlation with prenatal care coverage in the state of Bahia, Brazil, 2000-2020

MAIN RESULTS

From 2000 to 2020, maternal mortality among adolescents and young adults showed a decreasing trend in the state of Bahia. It could be seen an inverse and significant correlation between the highest number of prenatal care visits and maternal mortality in the studied groups.

IMPLICATIONS FOR SERVICES

The study suggests the importance of quality obstetric care during prenatal, childbirth, and postpartum period for reducing maternal mortality among adolescents and young adults, especially from preventable causes.

PERSPECTIVES

Improving the records of causes of death on information systems, enhancing obstetric care, and investing in sexual and reproductive health policies aimed at adolescents may contribute to the reduction of maternal deaths.

OBJECTIVE

to analyze the temporal trend of maternal mortality and correlate it with prenatal care coverage among adolescents and young adults, state of Bahia, Brazil, 2000-2020.

METHODS

this was an ecological time-series study and correlation between maternal deaths and prenatal care visits in 10-19 and 20-24 age groups, using the Mortality Information System; the trend analysis was performed by means of Prais-Winsten regression, according to race/skin color, timing and causes of death; and Spearman coefficient was used for correlation.

RESULTS

in the study period, 418 deaths among adolescents and 574 among young adults were recorded; maternal mortality ratio was 59.7 and 63.2 deaths/100,000 live births, with a significant decreasing trend (-2.2% and -2.9% respectively); it could be seen an inverse correlation between a higher number of prenatal care visits and maternal mortality in the age groups.

CONCLUSION

maternal mortality showed a decreasing trend in the study period, but with high proportions of death; there was a significant correlation between prenatal care coverage and maternal mortality among adolescents and young adults.

Relationship between social development indicators and mortality due to Diabetes Mellitus in Brazil: a space-time analysis

OBJECTIVE

to identify the space-time pattern of mortality due to Diabetes Mellitus in Brazil, as well as its relationship with social development indicators.

METHOD

an ecological and time series nationwide study based on secondary data from the Unified Health System Informatics Department, with space-time analysis and inclusion of indicators in non-spatial and spatial regression models. The following was performed: overall mortality rate calculation; characterization of the sociodemographic and regional profiles of the death cases by means of descriptive and time analysis; and elaboration of thematic maps.

RESULTS

a total of 601,521 deaths related to Diabetes Mellitus were recorded in Brazil, representing a mean mortality rate of 29.5/100,000 inhabitants. The states of Rio Grande do Norte, Paraíba, Pernambuco, Alagoas and Sergipe, Rio de Janeiro, Paraná and Rio Grande do Sul presented high-high clusters. By using regression models, it was verified that the Gini index (β=11.7) and the Family Health Strategy coverage (β=3.9) were the indicators that most influenced mortality due to Diabetes Mellitus in Brazil.

CONCLUSION

in Brazil, mortality due to Diabetes presents an overall increasing trend, revealing itself as strongly associated with places that have worse social indicators.

HIGHLIGHTS

(1) The time-space pattern of mortality due to Diabetes presents an increasing trend. (2) The Northeast and South regions present high rates of mortality due to Diabetes. (3) Mortality due to Diabetes is associated with worse sociodemographic indicators. (4) A relationship is observed between income, access to health and mortality due to Diabetes.

Impact of the GeneXpert® MTB/RIF rapid molecular test on tuberculosis detection: temporal trends and vulnerable territories

OBJECTIVE

to assess the impact of the GeneXpert® MTB/RIF rapid molecular test on tuberculosis detection, to analyze the temporal trend of the event and to identify vulnerable territories in a Brazilian municipality.

METHOD

an ecological study carried out in Ribeirão Preto, São Paulo, Brazil, a municipality considered a priority in tuberculosis control due to the high number of cases. To classify the temporal trend, the Prais-Winsten method and the Interrupted Time Series were used to identify changes in the disease incidence. Kernel intensity analysis was applied to identify vulnerable areas.

RESULTS

the temporal trend of tuberculosis decreased by 18.1%/year and by 6.9%/year for children under 15 years old. The North District decreased by 6.67%/year and the East District increased by 17.5%/year in the incidence of tuberculosis. Resistant tuberculosis, after the implementation of the Rapid Molecular Test, increased by 0.6% per year. The South and West Districts showed a higher density of cases, with a range from 45 to 79 tuberculosis cases per square kilometer (km2).

CONCLUSION

although resistant tuberculosis is not a problem in the scenario, the study showed an increase in its incidence, which puts it on alert. The use of spatial analysis enabled the identification of priority areas, putting them in evidence for health surveillance actions.

Is it possible to eliminate hepatitis C from the prisons of Catalonia, Spain, in 2021?

AIM

Predict the elimination of chronic hepatitis C in Catalan prisons.

MATERIAL AND METHOD

We analyzed the trend of the prevalence of HCV-RNA and anti-hepatitis C treatments prescribed in Catalonia in the period 2002-2016. Using linear exponential smoothing from the historical values in the time series, we estimate the time required to eliminate hepatitis C as a public health problem in prisons (prevalence of hepatitis C virus RNA<1%).

RESULTS

A total of 1264 treatments were administered by 12/31/2016. The prevalence of hepatitis C virus RNA was 31.2% in 2002, decreasing to 8.81% in 2016. We estimate that prevalence will reach 0-0.5% in 5 years (second half 2021; 95% CI: 2019-2025).

DISCUSSION

Appropriate actions can eliminate hepatitis C infection in prisoners. We estimate that by 2021 hepatitis C infection will no longer be a public health problem in Catalonia prisons.