Soeiro Vanessa Moreira da Silva, Vasconcelos Vitor Vieira, Caldas Arlene de Jesus Mendes
Universidade Federal do Maranhão Programa de Pós-Graduação em Saúde Coletiva São Luís (MA) Brasil Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde Coletiva, São Luís (MA), Brasil.
Universidade Federal do ABC Programa de Pós-Graduação em Ciência e Tecnologia Ambiental São Bernardo do Campo (SP) Brasil Universidade Federal do ABC, Programa de Pós-Graduação em Ciência e Tecnologia Ambiental, São Bernardo do Campo (SP), Brasil.
Rev Panam Salud Publica. 2022 May 24;46:e51. doi: 10.26633/RPSP.2022.51. eCollection 2022.
To describe the spatial distribution of tuberculosis-diabetes comorbidity and identify the social determinants of the double burden of disease in the period from 2012 to 2018 in Brazil.
In the present ecological study, municipalities were the unit of analysis. All cases of tuberculosis reported from 2012 to 2018 to the National Notifiable Disease Information System SINAN were included. Socioeconomic variables covering employment, income, and development, and the primary care coverage indicator were analyzed as determinants. The global Moran's I statistic was used to verify spatial autocorrelation in the comorbidity rate. The local Moran statistic was used to delimit tuberculosis-diabetes clusters: high/high cluster (municipalities with high rates of tuberculosis-diabetes comorbidity with neighboring municipalities also presenting high comorbidity rates) and low/low cluster (municipalities with tuberculosis-diabetes comorbidity below the mean, surrounded by municipalities with low comorbidity rates).
A high proportion of tuberculosis-diabetes was detected in most Brazilian regions. Spatial autocorrelation was observed for tuberculosis-diabetes comorbidity, as well as a high-high comorbidity cluster encompassing 88 municipalities located mostly in the Northeast, Southeast, and South, with mean tuberculosis-diabetes prevalence of 28.04%. The variables "percent population living in households with more than two people per bedroom," "percent unemployment in the population above 18 years of age" and " income" were associated with the presence of comorbidity.
The results showed a non-random distribution of tuberculosis-diabetes comorbidity, with high-risk areas and associated explanatory variables. The findings underscore the need to operationalize cooperation between tuberculosis and diabetes programs, with the aim of controlling both the individual diseases and the tuberculosis-diabetes syndemic.
描述巴西2012年至2018年期间结核病-糖尿病合并症的空间分布，并确定该双重疾病负担的社会决定因素。
在本生态研究中，以市为分析单位。纳入2012年至2018年向国家法定传染病信息系统SINAN报告的所有结核病病例。分析涵盖就业、收入和发展的社会经济变量以及初级保健覆盖指标作为决定因素。使用全局莫兰指数统计量来验证合并症发生率的空间自相关性。使用局部莫兰统计量来划定结核病-糖尿病聚集区：高/高聚集区（结核病-糖尿病合并症发生率高且周边市合并症发生率也高的市）和低/低聚集区（结核病-糖尿病合并症低于平均水平且周边市合并症发生率低的市）。
在巴西大部分地区检测到高比例的结核病-糖尿病合并症。观察到结核病-糖尿病合并症存在空间自相关性，以及一个高-高合并症聚集区，包括88个市，主要位于东北部、东南部和南部，结核病-糖尿病平均患病率为28.04%。变量“居住在每间卧室住两人以上家庭的人口百分比”、“18岁以上人口失业率”和“收入”与合并症的存在相关。
结果显示结核病-糖尿病合并症分布并非随机，存在高危地区及相关解释变量。研究结果强调了结核病和糖尿病项目开展合作的必要性，以控制这两种疾病以及结核病-糖尿病综合征。
