Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeirão Preto, Brazil
Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeirão Preto, Brazil.
BMJ Open. 2020 Aug 20;10(8):e034074. doi: 10.1136/bmjopen-2019-034074.
To identify the risk areas of deaths due to unspecified pneumonia and tuberculosis (TB) in children, and to identify if there is a relationship between these events with higher TB incidence and social determinants.
Ecological study carried out in Brazil. All cases of TB or unspecified pneumonia deaths in children under 5 years of age reported between 2006 and 2016 were included and collected through Department of Informatics of the Unified Health System (Brazil's electronic database). The Spatial Scan Statistics was used to identify areas at higher risk of dying from this event. The spatial association was verified through the Getis-Ord techniques. The Bivariate Moran Global Index was used to verify the spatial autocorrelation between the two events. To identify the association of TB and pneumonia deaths with endemic areas of pulmonary TB and social determinants, four explanatory statistical models were identified.
A total of 21 391 cases of pneumonia and 238 cases of TB were identified. Spatial scanning analysis enabled the detection of four clusters of risk for TB (relative risk, RR, between 3.30 and 18.18) and 22 clusters for pneumonia (RR between 1.38 and 5.24). The spatial association of the events was confirmed (z-score 3.74 and 64.34) and spatial autocorrelation between events (Moran Index:0.031 (p=0.001)). The zero-inflated negative binomial distribution was chosen, and an association for both events was identified with the TB incidence rate (OR 5.3, 95% CI 2.85 to 9.84; OR 6.63, 95% CI 5.62 to 7.81), with the Gini Index (OR 1.78, 95% CI 1.12 to 2.82; OR 4.22, 95% CI 3.63 to4.92). Primary care coverage showed an inverse association for both events (OR 0.10, 95% CI 0.67 to 0.17; OR 0.18, 95% CI 0.15 to 0.21) for pneumonia). Finally, a family that benefited from the Bolsa Família Programme had an inverse association for deaths from pneumonia (OR 0.81, 95% CI 0.52 to 1.25).
The results do not just contribute to reduce mortality in children, but mainly contribute to prevent premature deaths through identification of critical areas in Brazil, which is crucial to qualify health surveillance services.
确定导致儿童不明原因肺炎和结核病（TB）死亡的风险区域，并确定这些事件与较高的 TB 发病率和社会决定因素之间是否存在关系。
这是在巴西进行的一项生态学研究。纳入了 2006 年至 2016 年间报告的所有 5 岁以下儿童的 TB 或不明原因肺炎死亡病例，并通过统一卫生系统的信息部门收集这些病例数据（巴西电子数据库）。采用空间扫描统计方法来识别死于该事件的高风险地区。通过 Getis-Ord 技术验证空间相关性。使用双变量 Moran 全局指数来验证两个事件之间的空间自相关。为了确定 TB 和肺炎死亡与肺结核地方性流行地区和社会决定因素之间的关联，确定了四个解释性统计模型。
共发现 21391 例肺炎和 238 例 TB。空间扫描分析检测到 4 个 TB 风险聚集区（相对风险 RR 为 3.30 至 18.18）和 22 个肺炎聚集区（RR 为 1.38 至 5.24）。事件的空间关联得到了确认（z 分数分别为 3.74 和 64.34），并且事件之间存在空间自相关（莫兰指数：0.031（p=0.001））。选择了零膨胀负二项分布，并确定了两个事件与 TB 发病率（比值比 5.3，95%置信区间 2.85 至 9.84；比值比 6.63，95%置信区间 5.62 至 7.81）和基尼指数（比值比 1.78，95%置信区间 1.12 至 2.82；比值比 4.22，95%置信区间 3.63 至 4.92）之间存在关联。初级保健覆盖率与两个事件均呈负相关（肺炎的比值比 0.10，95%置信区间 0.67 至 0.17；比值比 0.18，95%置信区间 0.15 至 0.21）。最后，受益于“Bolsa Família 计划”的家庭，肺炎死亡率呈负相关（比值比 0.81，95%置信区间 0.52 至 1.25）。
研究结果不仅有助于降低儿童死亡率，而且主要有助于通过识别巴西的关键地区来预防过早死亡，这对于提高卫生监测服务质量至关重要。
