Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil.
Department of Nursing, Federal University of Sergipe, Lagarto, Brazil.
PLoS Negl Trop Dis. 2021 Jan 19;15(1):e0009006. doi: 10.1371/journal.pntd.0009006. eCollection 2021 Jan.
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.
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.
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.
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.
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.
尽管内脏利什曼病（VL）在巴西大多数地区流行，但东北地区是该国发病率和死亡率最高的地区。
分析 VL 病例的时空动态，以确定 VL 传播的时间趋势和高风险地区，以及该疾病与巴西东北部社会脆弱性的关系。
我们进行了一项生态时间序列研究，使用空间分析技术，分析了巴西东北部 1794 个城市 2000 年至 2017 年所有 VL 确诊病例。使用社会脆弱性指数（SVI）来表示社会脆弱性。发病率通过局部经验贝叶斯方法进行标准化和平滑处理。通过分段线性回归检查时间趋势。时空分析包括单变量和双变量全局和局部 Moran 指数以及时空扫描统计。
发病率保持稳定，范围为 4.84 至 3.52 例/100,000 居民。男性（62.71%）、儿童和青少年（63.27%）、非白人（69.75%）和城市居民（62.58%）的病例患病率较高。成年男性（≥40 岁）和城市居民中新病例的增加趋势明显。重要的是，VL 发病率表现出直接的空间依赖性。在 sertão 和 meio-norte 次区域发现了空间和时空聚类，与高社会脆弱性地区重叠。
VL 是巴西东北部持续存在的健康问题，与社会脆弱性有关。社会脆弱性高的城市中 VL 病例的时空聚类需要采取跨部门的监测和控制公共政策，重点是减少不平等和改善该地区居民的生活条件。
