Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Centro de Integração de Dados e Conhecimento para a Saúde(CIDACS), Gonçalo Moniz Institute, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.
PLoS Negl Trop Dis. 2022 Jul 27;16(7):e0010602. doi: 10.1371/journal.pntd.0010602. eCollection 2022 Jul.
In addition to their direct pathogenic effects, arthropod-borne (arboviruses) have been hypothesized to indirectly contribute to hospitalizations and death through decompensation of pre-existing comorbidities. Using nationwide data routinely collected from 1 January 2014 to 31 December 2019 in Brazil, we investigated whether local increases in arbovirus notifications were associated with excess hospitalization.
We estimated the relative risks for the association between municipality- and state-level increases in arboviral case notifications and age-standardized hospitalization rates (i.e., classified as direct or indirect based on ICD-10 codes) using Bayesian multilevel models with random effects accounting for temporal and geographic correlations. For municipality-level analyses, we excluded municipalities with <200 notifications of a given arbovirus and further adjusted the models for the local Gini Index, Human Development Index, and Family Healthcare Strategy (Estratégia de Saúde da Família) coverage. Models for dengue, Zika, and chikungunya were performed separately.
From 2014 to 2019, Brazil registered 7,566,330 confirmed dengue cases, 159,029 confirmed ZIKV cases, and 433,887 confirmed CHIKV cases. Dengue notifications have an endemic and seasonal pattern, with cases present in 5334 of the 5570 (95.8%) Brazilian municipalities and most (69.5%) registered between February and May. Chikungunya notifications followed a similar seasonal pattern to DENV but with a smaller incidence and were restricted to 4390 (78.8%) municipalities. ZIKV was only notified in 2581 (46.3%) municipalities. Increases in dengue and chikungunya notifications were associated with small increases in age-standardized arbovirus-related hospitalizations, but no consistent association was found with all-cause or other specific indirect causes of hospitalization. Zika was associated to increases in hospitalizations by neurological diseases.
Although we found no clear association between increased incidence of the three arboviruses and excess risks of all-cause or indirect hospitalizations at the municipality- and state-levels, follow-up investigations at the individual-level are warranted to define any potential role of acute arbovirus infection in exacerbating risks of hospitalization from underlying conditions.
除了直接的致病作用外，虫媒病毒（arboviruses）还被假设通过加重先前存在的合并症而间接导致住院和死亡。本研究使用巴西从 2014 年 1 月 1 日至 2019 年 12 月 31 日期间常规收集的全国性数据，调查了地方虫媒病毒通知的增加是否与超额住院有关。
我们使用贝叶斯多层次模型估计了市县级和州级虫媒病毒病例通知增加与年龄标准化住院率（即根据 ICD-10 代码分类为直接或间接）之间的关联的相对风险，该模型具有随机效应，可考虑时间和地理相关性。对于市县级分析，我们排除了通知少于 200 例特定虫媒病毒的市，并且还进一步调整了模型以考虑当地基尼指数、人类发展指数和家庭医疗保健策略（Estratégia de Saúde da Família）覆盖率。单独进行了登革热、寨卡病毒和基孔肯雅热的模型分析。
2014 年至 2019 年，巴西共登记了 7566330 例确诊登革热病例、159029 例确诊寨卡病毒病例和 433887 例确诊基孔肯雅热病例。登革热通知具有地方性和季节性模式，5570 个巴西市中有 5334 个（95.8%）有病例，大多数（69.5%）病例发生在 2 月至 5 月之间。基孔肯雅热通知与 DENV 相似，具有季节性模式，但发病率较低，仅限于 4390 个（78.8%）市。寨卡病毒仅在 2581 个（46.3%）市有通知。登革热和基孔肯雅热通知的增加与年龄标准化 arbovirus 相关住院率的小幅度增加有关，但与全因或其他特定间接住院原因无一致关联。寨卡病毒与神经疾病引起的住院增加有关。
尽管我们没有发现这三种 arboviruses 发病率增加与市县级和州级全因或间接住院的超额风险之间存在明确关联，但需要进行个体水平的后续调查，以确定急性 arbovirus 感染在加重潜在疾病住院风险方面的任何潜在作用。
