Graduate Program in Parasitic Biology, Universidade Federal de Sergipe, São Cristóvão, Sergipe, Brazil.
HDT Bio, Seattle, Washington, USA.
Acta Trop. 2021 Jun;218:105897. doi: 10.1016/j.actatropica.2021.105897. Epub 2021 Mar 20.
Schistosomiasis remains a significant public health concern in Brazil. To identify areas at, and social determinants of health (SDH) associated with, high-risk for schistosomiasis-related mortality from Brazil, we conducted a spatial and spatiotemporal modeling assessing all deaths confirmed in Brazil between 1999 and 2018. We used the segmented log-linear regression model to assess temporal trends, and the local empirical Bayesian estimator, the Global and Local Moran Index for spatial analysis. A total of 12,251 schistosomiasis-related deaths were reported in this period. Within the Mortality Information System (SIM) of the Brazilian Ministry of Health, the states of Alagoas (AL), Pernambuco (PE) and Sergipe (SE) recording the highest mortality rates: 2.21, 1.92 and 0.80 deaths/100,000 inhabitants, respectively. Analyses revealed an increase in the mean age of schistosomiasis-related deaths over the time assessed (APC = 0.9; p-value<0.05). Spatial analysis identified a concentration of municipalities presenting high risk of schistosomiasis-related mortality along the coastline of PE and AL. Similarly, we identified the formation of high space-time clusters in municipalities in the states of PE, AL, SE, Bahia, and Minas Gerais. Finally, mortality rates showed a significant correlation with 96.96% of SDH indices. The data reveal additional important changes in schistosomiasis-related deaths in Brazil between 1999 and 2018, such as a slow reduction among males (unlike females that displayed no change). Regardless, our analyses indicates that schistosomiasis continues to have the greatest detrimental impact in poor regions of Brazil and suggest the need for enhancement of current control measures to accelerate progress.
巴西血吸虫病仍然是一个重大的公共卫生问题。为了确定巴西血吸虫病相关死亡率高的地区及其与健康的社会决定因素（SDH），我们进行了空间和时空建模，评估了 1999 年至 2018 年期间巴西所有确诊的死亡病例。我们使用分段对数线性回归模型来评估时间趋势，使用局部经验贝叶斯估计、全局和局部 Moran 指数进行空间分析。在此期间，共报告了 12251 例与血吸虫病相关的死亡病例。在巴西卫生部的死亡率信息系统（SIM）中，阿拉戈斯州（AL）、伯南布哥州（PE）和塞尔希培州（SE）的死亡率最高，分别为 2.21、1.92 和 0.80 例/10 万居民。分析显示，与血吸虫病相关的死亡人数的平均年龄在评估期间有所增加（APC=0.9；p 值<0.05）。空间分析确定了在 PE 和 AL 海岸线沿线存在高风险的血吸虫病相关死亡率的市集中心。同样，我们还确定了在 PE、AL、SE、巴伊亚和米纳斯吉拉斯州的市中形成了高时空聚类。最后，死亡率与 96.96%的 SDH 指数呈显著相关。这些数据显示，1999 年至 2018 年间，巴西与血吸虫病相关的死亡人数发生了更多重要变化，例如男性的死亡率缓慢下降（而女性的死亡率没有变化）。尽管如此，我们的分析表明，血吸虫病继续对巴西的贫困地区产生最大的不利影响，并表明需要加强当前的控制措施，以加速进展。
