Danielle Talita dos Santos

Spatial clustering and local risk of leprosy in São Paulo, Brazil

Background Although the detection rate is decreasing, the proportion of new cases with WHO grade 2 disability (G2D) is increasing, creating concern among policy makers and the Brazilian government. This study aimed to identify spatial clustering of leprosy and classify high-risk areas in a major leprosy cluster using the SatScan method. Methods Data were obtained including all leprosy cases diagnosed between January 2006 and December 2013. In addition to the clinical variable, information was also gathered regarding the G2D of the patient at diagnosis and after treatment. The Scan Spatial statistic test, developed by Kulldorff e Nagarwalla, was used to identify spatial clustering and to measure the local risk (Relative Risk—RR) of leprosy. Maps considering these risks and their confidence intervals were constructed. Results A total of 434 cases were identified, including 188 (43.31%) borderline leprosy and 101 (23.28%) lepromatous leprosy cases. There was a predominance of males, with ages ranging from 15 to 59 years, and 51 patients (11.75%) presented G2D. Two significant spatial clusters and three significant spatial-temporal clusters were also observed. The main spatial cluster (p = 0.000) contained 90 census tracts, a population of approximately 58,438 inhabitants, detection rate of 22.6 cases per 100,000 people and RR of approximately 3.41 (95%CI = 2.721–4.267). Regarding the spatial-temporal clusters, two clusters were observed, with RR ranging between 24.35 (95%CI = 11.133–52.984) and 15.24 (95%CI = 10.114–22.919). Conclusion These findings could contribute to improvements in policies and programming, aiming for the eradication of leprosy in Brazil. The Spatial Scan statistic test was found to be an interesting resource for health managers and healthcare professionals to map the vulnerability of areas in terms of leprosy transmission risk and areas of underreporting.

Patrón espacial y tendencia temporal de la mortalidad debido a la tuberculosis

Objetivos: describir el perfil epidemiologico de la mortalidad por tuberculosis (TB), analizar el patron espacial de estas muertes e investigar la tendencia temporal de la mortalidad por tuberculosis en el noreste de Brasil. Metodos: estudio ecologico basado en datos secundarios de mortalidad. Las muertes por TB se incluyeron en el estudio. Se calcularon las estadisticas descriptivas y se estimaron y suavizaron las tasas de mortalidad bruta mediante el Metodo Bayesiano Empirico Local. La regresion de Prais-Winsten se utilizo para analizar la tendencia temporal en los coeficientes de mortalidad por TB. La tecnica de densidad de Kernel se utilizo para analizar la distribucion espacial de la mortalidad por TB. Resultados: la tuberculosis estuvo presente en 236 muertes. El peso de muertes por tuberculosis fue mayor en hombres, personas solteras y personas de origen etnico mixto y la edad media al momento de la muerte fue de 51 anos. Las muertes por tuberculosis se agruparon en los distritos de salud del este, oeste y norte y el coeficiente de mortalidad por tuberculosis se mantuvo estable durante todo el periodo de estudio. Conclusiones: los analisis del patron espacial y la tendencia temporal de la mortalidad revelaron que ciertas areas con tasas mas altas de mortalidad por TB y, por lo tanto, deberian ser priorizadas en las intervenciones de salud publica dirigidas a esta enfermedad.ABSTRACT Objectives: To describe the epidemiological profile of mortality due to tuberculosis (TB), to analyze the spatial pattern of these deaths and to investigate the temporal trend in mortality due to tuberculosis in Northeast Brazil. Methods: An ecological study based on secondary mortality data. Deaths due to TB were included in the study. Descriptive statistics were calculated and gross mortality rates were estimated and smoothed by the Local Empirical Bayesian Method. Prais-Winsten’s regression was used to analyze the temporal trend in the TB mortality coefficients. The Kernel density technique was used to analyze the spatial distribution of TB mortality. Results: Tuberculosis was implicated in 236 deaths. The burden of tuberculosis deaths was higher amongst males, single people and people of mixed ethnicity, and the mean age at death was 51 years. TB deaths were clustered in the East, West and North health districts, and the tuberculosis mortality coefficient remained stable throughout the study period. Conclusions: Analyses of the spatial pattern and temporal trend in mortality revealed that certain areas have higher TB mortality rates, and should therefore be prioritized in public health interventions targeting the disease.

Padrão espacial e tendência temporal da mortalidade por tuberculose

Objetivos: describir el perfil epidemiologico de la mortalidad por tuberculosis (TB), analizar el patron espacial de estas muertes e investigar la tendencia temporal de la mortalidad por tuberculosis en el noreste de Brasil. Metodos: estudio ecologico basado en datos secundarios de mortalidad. Las muertes por TB se incluyeron en el estudio. Se calcularon las estadisticas descriptivas y se estimaron y suavizaron las tasas de mortalidad bruta mediante el Metodo Bayesiano Empirico Local. La regresion de Prais-Winsten se utilizo para analizar la tendencia temporal en los coeficientes de mortalidad por TB. La tecnica de densidad de Kernel se utilizo para analizar la distribucion espacial de la mortalidad por TB. Resultados: la tuberculosis estuvo presente en 236 muertes. El peso de muertes por tuberculosis fue mayor en hombres, personas solteras y personas de origen etnico mixto y la edad media al momento de la muerte fue de 51 anos. Las muertes por tuberculosis se agruparon en los distritos de salud del este, oeste y norte y el coeficiente de mortalidad por tuberculosis se mantuvo estable durante todo el periodo de estudio. Conclusiones: los analisis del patron espacial y la tendencia temporal de la mortalidad revelaron que ciertas areas con tasas mas altas de mortalidad por TB y, por lo tanto, deberian ser priorizadas en las intervenciones de salud publica dirigidas a esta enfermedad.ABSTRACT Objectives: To describe the epidemiological profile of mortality due to tuberculosis (TB), to analyze the spatial pattern of these deaths and to investigate the temporal trend in mortality due to tuberculosis in Northeast Brazil. Methods: An ecological study based on secondary mortality data. Deaths due to TB were included in the study. Descriptive statistics were calculated and gross mortality rates were estimated and smoothed by the Local Empirical Bayesian Method. Prais-Winsten’s regression was used to analyze the temporal trend in the TB mortality coefficients. The Kernel density technique was used to analyze the spatial distribution of TB mortality. Results: Tuberculosis was implicated in 236 deaths. The burden of tuberculosis deaths was higher amongst males, single people and people of mixed ethnicity, and the mean age at death was 51 years. TB deaths were clustered in the East, West and North health districts, and the tuberculosis mortality coefficient remained stable throughout the study period. Conclusions: Analyses of the spatial pattern and temporal trend in mortality revealed that certain areas have higher TB mortality rates, and should therefore be prioritized in public health interventions targeting the disease.

Spatial pattern and temporal trend of mortality due to tuberculosis

Objetivos: describir el perfil epidemiologico de la mortalidad por tuberculosis (TB), analizar el patron espacial de estas muertes e investigar la tendencia temporal de la mortalidad por tuberculosis en el noreste de Brasil. Metodos: estudio ecologico basado en datos secundarios de mortalidad. Las muertes por TB se incluyeron en el estudio. Se calcularon las estadisticas descriptivas y se estimaron y suavizaron las tasas de mortalidad bruta mediante el Metodo Bayesiano Empirico Local. La regresion de Prais-Winsten se utilizo para analizar la tendencia temporal en los coeficientes de mortalidad por TB. La tecnica de densidad de Kernel se utilizo para analizar la distribucion espacial de la mortalidad por TB. Resultados: la tuberculosis estuvo presente en 236 muertes. El peso de muertes por tuberculosis fue mayor en hombres, personas solteras y personas de origen etnico mixto y la edad media al momento de la muerte fue de 51 anos. Las muertes por tuberculosis se agruparon en los distritos de salud del este, oeste y norte y el coeficiente de mortalidad por tuberculosis se mantuvo estable durante todo el periodo de estudio. Conclusiones: los analisis del patron espacial y la tendencia temporal de la mortalidad revelaron que ciertas areas con tasas mas altas de mortalidad por TB y, por lo tanto, deberian ser priorizadas en las intervenciones de salud publica dirigidas a esta enfermedad.ABSTRACT Objectives: To describe the epidemiological profile of mortality due to tuberculosis (TB), to analyze the spatial pattern of these deaths and to investigate the temporal trend in mortality due to tuberculosis in Northeast Brazil. Methods: An ecological study based on secondary mortality data. Deaths due to TB were included in the study. Descriptive statistics were calculated and gross mortality rates were estimated and smoothed by the Local Empirical Bayesian Method. Prais-Winsten’s regression was used to analyze the temporal trend in the TB mortality coefficients. The Kernel density technique was used to analyze the spatial distribution of TB mortality. Results: Tuberculosis was implicated in 236 deaths. The burden of tuberculosis deaths was higher amongst males, single people and people of mixed ethnicity, and the mean age at death was 51 years. TB deaths were clustered in the East, West and North health districts, and the tuberculosis mortality coefficient remained stable throughout the study period. Conclusions: Analyses of the spatial pattern and temporal trend in mortality revealed that certain areas have higher TB mortality rates, and should therefore be prioritized in public health interventions targeting the disease.

Social determinants, their relationship with leprosy risk and temporal trends in a tri-border region in Latin America

Background Brazil is the only country in Latin America that has adopted a national health system. This causes differences in access to health among Latin American countries and induces noticeable migration to Brazilian regions to seek healthcare. This phenomenon has led to difficulties in the control and elimination of diseases related to poverty, such as leprosy. The aim of this study was to evaluate social determinants and their relationship with the risk of leprosy, as well as to examine the temporal trend of its occurrence in a Brazilian municipality located on the tri-border area between Brazil, Paraguay and Argentina. Methods This ecological study investigated newly-diagnosed cases of leprosy between 2003 and 2015. Exploratory analysis of the data was performed through descriptive statistics. For spatial analysis, geocoding of the data was performed using spatial scan statistic techniques to obtain the Relative Risk (RR) for each census tract, with their respective 95% confidence intervals calculated. The Bivariate Moran I test, Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR) models were applied to analyze the spatial relationships of social determinants and leprosy risk. The temporal trend of the annual coefficient of new cases was obtained through the Prais-Winsten regression. A standard error of 5% was considered statistically significant (p < 0.05). Results Of the 840 new cases identified in the study, there was a predominance of females (n = 427, 50.8%), of white race/color (n = 685, 81.6%), age range 15 to 59 years (n = 624, 74.3%), and incomplete elementary education (n = 504, 60.0%). The results obtained from multivariate analysis revealed that the proportion of households with monthly nominal household income per capita greater than 1 minimum wage (β = 0.025, p = 0.036) and people of brown race (β = -0.101, p = 0.024) were statistically-significantly associated with risk of illness due to leprosy. These results also confirmed that social determinants and risk of leprosy were significantly spatially non-stationary. Regarding the temporal trend, a decrease of 4% (95% CI [-0.053, -0.033], p = 0.000) per year was observed in the rate of detection of new cases of leprosy. Conclusion The social determinants income and race/color were associated with the risk of leprosy. The study’s highlighting of these social determinants can contribute to the development of public policies directed toward the elimination of leprosy in the border region.

How do social-economic differences in urban areas affect tuberculosis mortality in a city in the tri-border region of Brazil, Paraguay and Argentina

BackgroundThe World Health Organization (WHO) launched the “End TB Strategy”, which aims to reduce tuberculosis (TB) mortality by 95% by 2035, Brazil has made a commitment to this, however, one challenge is achieving the goal in the border region, where the TB situation is more critical. The proposal was to analyse the spatial mortality due to TB and its socio-economic determinants in the general population, around the border areas of Brazil, Paraguay and Argentina, as well as the temporal trend in this region.MethodThis ecological study considered the cases of TB deaths of residents of Foz do Iguaçu (BR), with its units of analysis being the census sectors. The standardized mortality rate was calculated for each area. Socioeconomic variables data were obtained from the 2010 Demographic Census of the Brazilian Institute of Geography and Statistics (IBGE). The scan statistic was applied to calculate the spatial relative risk (RR), considering a 95% confidence interval (CI). Spatial dependence was analysed using the Global Bivariate Moran I and Local Bivariate Moran I (LISA) to test the relationship between the socioeconomic conditions of the urban areas and mortality from TB. Analysis of the temporal trend was also performed using the Prais-Winsten test.ResultsA total of 74 cases of TB death were identified, of which 53 (71.6%) were male and 51 (68.9%) people of white skin colour. The mortality rate ranged from 0.28 to 22.75 cases per 100,000 inhabitants. A spatial relative risk area was identified, RR = 5.07 (95% CI 1.79–14.30). Mortality was associated with: proportion of people of brown skin colour (I: 0.0440, p = 0.033), income (low income I: − 0.0611, p = 0.002; high income I: − 0.0449, p = 0.026) and density of residents (3 and 4 residents, I: 0.0537, p = 0.007; 10 or more residents, I: − 0.0390, p = 0.035). There was an increase in the mortality rate in people of brown skin colour (6.1%; 95% CI = 0.029, 0.093).ConclusionDeath due to TB was associated with income, race resident density and social conditions. Although the TB mortality rate is stationary in the general population, it is increasing among people of brown skin colour.

Spatial risk of tuberculosis mortality and social vulnerability in Northeast Brazil

INTRODUCTION Tuberculosis (TB) is the most common infectious disease in the world. We aimed to analyze the spatial risk of tuberculosis mortality and to verify associations in high-risk areas with social vulnerability. METHODS This was an ecological study. The scan statistic was used to detect areas at risk, and the Bivariate Moran Index was used to verify relationships between variables. RESULTS High-risk areas of tuberculosis mortality were statistically significantly associated with domain 2 of the Social Vulnerability Index (I=0.010; p=0.001). CONCLUSIONS This study provides evidence regarding areas with high risk and that vulnerability is a determinant of TB mortality.

Prevalence and evolution of Mycobacterium tuberculosis infection in tuberculosis case contacts

INTRODUCTION The tuberculin test is a diagnostic method for detecting latent tuberculosis (TB) infection, especially among disease contact cases. The objective of this study was to analyze the prevalence and evolution of Mycobacterium tuberculosis infection among TB contact cases. METHODS A retrospective cohort study was performed in a reference center for TB. The study population consisted of 2,425 patients who underwent a tuberculin test from 2003 to 2010 and whose results indicated contact with individuals with TB. The data were collected from the registry book of the tuberculin tests, patient files and the Information System Records of Notification Grievance. To verify the evolution of TB, case records through September 2014 were consulted. Data were analyzed using the Statistical Package for the Social Sciences (SPSS). In all hypothesis tests, a significance level of 0.05 was used. RESULTS From the studied sample, 435 (17.9%) contacts did not return for reading. Among the 1,990 contacts that completed the test, the prevalence of latent TB infection was 35.4%. Of these positive cases, 50.6% were referred to treatment; the dropout rate was 42.5%. Among all of the contacts, the TB prevalence was 1.8%, from which 13.2% abandoned treatment. CONCLUSIONS The collected data indicate the need for more effective public policies to improve TB control, including administering tests that do not require a return visit for reading, enhancing contact tracing and encouraging actions that reinforce full treatment adherence.