Lima Deanna Dos Santos, da Paz Wandklebson Silva, Lopes de Sousa Álvaro Francisco, de Andrade Denise, Conacci Beatriz Juliana, Damasceno Flávia Silva, Bezerra-Santos Márcio
Parasitic Diseases and Environment Graduate Program, Universidade Estadual de Alagoas-Campus II, Santana do Ipanema 57500-000, Alagoas, Brazil.
Tropical Medicine Graduate Program, Universidade Federal de Pernambuco, Recife 50670-901, Pernambuco, Brazil.
Trop Med Infect Dis. 2022 Oct 18;7(10):312. doi: 10.3390/tropicalmed7100312.
Acute diarrhea is the second leading cause of death among children in developing countries and is strongly related with the socioeconomic conditions of the population. In Brazil, data show a drop in the diarrhea mortality rate. Nevertheless, the northeastern region still has the most deaths. Considering this, we analyze high-risk areas for diarrhea- and gastroenteritis-related deaths, and their association with social determinants of health (SDH) in the state with one of the worst human development indicators in Brazil (Alagoas) between 2000 and 2019. We applied temporal, spatial, and space−time risk modelling. We used a log-linear regression model to assess temporal trends and the local empirical Bayesian estimator, the global and local Moran indices for spatial analysis. Spearman’s correlation was used to correlate mortality rates with SDH. A total of 3472 diarrhea-related deaths were reported during this period in Alagoas. We observed a decreasing time trend of deaths in the state (9.41/100,000 in 2000 to 2.21 in 2019; APC = −6.7; p-value < 0.001), especially in children under one year of age. However, there was stability among adults and the elderly. We identified two high-risk spatiotemporal clusters of mortality in inland municipalities. Lastly, mortality rates correlated significantly with 90% of SDH. Taken together, these findings indicate that diarrhea diseases remain a serious public health concern in Alagoas, mainly in the poorest and inland municipalities. Thereby, it is urgently necessary to invest in measures to control and prevent cases, and improve the living conditions of the poorest populations and those with the highest social vulnerability index.
急性腹泻是发展中国家儿童死亡的第二大主要原因，与人口的社会经济状况密切相关。在巴西，数据显示腹泻死亡率有所下降。然而，东北部地区的死亡人数仍然最多。考虑到这一点，我们分析了2000年至2019年期间巴西人类发展指标最差的州（阿拉戈斯州）腹泻和肠胃炎相关死亡的高风险地区，以及它们与健康社会决定因素（SDH）的关联。我们应用了时间、空间和时空风险建模。我们使用对数线性回归模型来评估时间趋势，并使用局部经验贝叶斯估计器、全局和局部莫兰指数进行空间分析。使用斯皮尔曼相关性来关联死亡率与健康社会决定因素。在此期间，阿拉戈斯州共报告了3472例腹泻相关死亡病例。我们观察到该州的死亡时间趋势呈下降趋势（2000年为9.41/10万，2019年为2.21；年度百分比变化率=−6.7；p值<0.001），尤其是一岁以下儿童。然而，成年人和老年人的死亡率保持稳定。我们在内陆市镇确定了两个高风险的时空死亡聚集区。最后，死亡率与90%的健康社会决定因素显著相关。综上所述，这些发现表明腹泻疾病在阿拉戈斯州仍然是一个严重的公共卫生问题，主要集中在最贫困的内陆市镇。因此，迫切需要投资采取措施来控制和预防病例，并改善最贫困人群和社会脆弱性指数最高人群的生活条件。
