RESUMO
BACKGROUND: Despite visceral leishmaniasis (VL) being epidemic in most Brazilian regions, the Northeast region is responsible for the highest morbidity and mortality outcomes within the country. OBJECTIVE: To analyse the spatiotemporal dynamics of VL cases to identify the temporal trends and high-risk areas for VL transmission, as well as the association of the disease with social vulnerability in Brazilian Northeast. METHODS: We carried out an ecological time series study employing spatial analysis techniques using all VL confirmed cases of 1,794 municipalities of Brazilian Northeast between the years 2000 to 2017. The Social Vulnerability Index (SVI) was used to represent the social vulnerability. Incidence rates were standardized and smoothed by the Local Empirical Bayesian Method. Time trends were examined through segmented linear regression. Spatiotemporal analysis consisted of uni- and bivariate Global and Local Moran indexes and space-time scan statistics. RESULTS: Incidence rate remained stable and ranged from 4.84 to 3.52 cases/100,000 inhabitants. There was higher case prevalence between males (62.71%), children and adolescents (63.27%), non-white (69.75%) and urban residents (62.58%). Increasing trends of new cases were observed among adult male subjects (≥ 40 years old) and urban residents. Importantly, VL incidence showed a direct spatial dependence. Spatial and space-time clusters were identified in sertão and meio-norte sub-regions, overlapping with high social vulnerability areas. CONCLUSIONS: VL is a persistent health issue in Brazilian Northeast and associated with social vulnerability. Space-time clustering of VL cases in socially vulnerable municipalities demands intersectoral public policies of surveillance and control, with focus on reducing inequalities and improving living conditions for regional inhabitants.
Assuntos
Leishmaniose Visceral/epidemiologia , Fatores Socioeconômicos , Análise Espaço-Temporal , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Leishmaniose Visceral/transmissão , Masculino , Pessoa de Meia-Idade , Populações VulneráveisRESUMO
BACKGROUND: Leptospirosis is an endemic disease in Brazil of social and economic relevance related to behavioural and socioenvironmental factors. This study aimed to analyse the spatiotemporal distribution of the incidence of leptospirosis and its association with social determinants in health in a state of northeastern Brazil. METHODS: An ecological study of temporal series with techniques of spatial analysis using secondary data of the cases of leptospirosis notified in the Information System of Notifiable Diseases of the state of Sergipe (2008-2017) was conducted. The analysis of temporal trends was performed using Poisson regression. Spatial analyses were performed using the Moran index, the local empirical Bayesian model, scan statistics and spatial regression. RESULTS: The incidence rate decreased from 3.66 to 1.44 cases per 100 000 inhabitants in 2008 and 2017, respectively. Leptospirosis was associated with social inequities, mostly affecting males aged 20-49 y living in urban areas. The space-time scan indicated the formation of a risk cluster in municipalities in the metropolitan region of the state. CONCLUSIONS: The data indicated the persistence of leptospirosis transmission, maintaining a pattern of high endemicity in some municipalities associated with social inequities. The study showed the temporal and spatial dynamics of the disease to better target specific actions for prevention and control.