NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisboa, Portugal.
Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Lisboa, Portugal.
Eur J Public Health. 2021 Feb 1;31(1):57-62. doi: 10.1093/eurpub/ckaa161.
Tuberculosis (TB) causes pressure on healthcare resources, especially in terms of hospital admissions, despite being considered an ambulatory care-sensitive condition for which timely and effective care in ambulatory setting could prevent the need for hospitalization. Our objectives were to describe the spatial and temporal variation in pulmonary tuberculosis (PTB) hospitalizations, identify critical geographic areas at municipality level and characterize clusters of PTB hospitalizations to help the development of tailored disease management strategies that could improve TB control.
Ecologic study using sociodemographic, geographical and clinical information of PTB hospitalization cases from continental Portuguese public hospitals, between 2002 and 2016. Descriptive statistics, spatiotemporal cluster analysis and temporal trends were conducted.
The space-time analysis identified five clusters of higher rates of PTB hospitalizations (2002-16), including the two major cities in the country (Lisboa and Porto). Globally, we observed a -7.2% mean annual percentage change in rate with only one of the identified clusters (out of six) with a positive trend (+4.34%). In the more recent period (2011-16) was obtained a mean annual percentage change in rate of -8.12% with only one cluster identified with an increase trend (+9.53%).
Our results show that space-time clustering and temporal trends analysis can be an invaluable resource to monitor the dynamic of the disease and contribute to the design of more effective, focused interventions. Interventions such as enhancing the detection of active and latent infection, improving monitoring and evaluation of treatment outcomes or adjusting the network of healthcare providers should be tailored to the specific needs of the critical areas identified.
结核病（TB）对医疗资源造成压力，尤其是在住院方面，尽管它被认为是一种适合在门诊治疗的疾病，及时有效的门诊治疗可以预防住院的需要。我们的目的是描述肺结核（PTB）住院的时空变化，确定市级层面的关键地理区域，并对 PTB 住院病例进行聚类分析，以帮助制定有针对性的疾病管理策略，改善结核病控制。
这是一项使用 2002 年至 2016 年葡萄牙大陆公立医院肺结核住院患者的社会人口学、地理和临床信息的生态研究。进行了描述性统计、时空聚类分析和时间趋势分析。
时空分析确定了五个肺结核住院率较高的聚类（2002-16 年），其中包括该国的两个主要城市（里斯本和波尔图）。总体而言，我们观察到发病率的年平均百分比变化率为-7.2%，只有六个聚类中的一个（+4.34%）呈正趋势。在最近的时期（2011-16 年），发病率的年平均百分比变化率为-8.12%，只有一个聚类（+9.53%）呈上升趋势。
我们的结果表明，时空聚类和时间趋势分析可以成为监测疾病动态和设计更有效、更有针对性的干预措施的宝贵资源。应根据确定的关键区域的具体需求，采取增强活动性和潜伏性感染检测、改善治疗结果监测和评估或调整医疗服务提供者网络等干预措施。
