Abstract
BackgroundTuberculosis (TB) is the infectious disease that kills the most people worldwide. The use of geoepidemiological techniques to demonstrate the dynamics of the disease in vulnerable communities is essential for its control. Thus, this study aimed to identify risk clusters for TB deaths and their variation over time.MethodsThis ecological study considered cases of TB deaths in residents of Londrina, Brazil between 2008 and 2015. We used standard, isotonic scan statistics for the detection of spatial risk clusters. The Poisson discrete model was adopted with the high and low rates option used for 10, 30 and 50% of the population at risk, with circular format windows and 999 replications considered the maximum cluster size. Getis-Ord Gi* (Gi*) statistics were used to diagnose hotspot areas for TB mortality. Kernel density was used to identify whether the clusters changed over time.ResultsFor the standard version, spatial risk clusters for 10, 30 and 50% of the exposed population were 4.9 (95% CI 2.6–9.4), 3.2 (95% CI: 2.1–5.7) and 3.2 (95% CI: 2.1–5.7), respectively. For the isotonic spatial statistics, the risk clusters for 10, 30 and 50% of the exposed population were 2.8 (95% CI: 1.5–5.1), 2.7 (95% CI: 1.6–4.4), 2.2 (95% CI: 1.4–3.9), respectively. All risk clusters were located in the eastern and northern regions of the municipality. Additionally, through Gi*, hotspot areas were identified in the eastern and western regions.ConclusionsThere were important risk areas for tuberculosis mortality in the eastern and northern regions of the municipality. Risk clusters for tuberculosis deaths were observed in areas where TB mortality was supposedly a non-problem. The isotonic and Gi* statistics were more sensitive for the detection of clusters in areas with a low number of cases; however, their applicability in public health is still restricted.
Highlights
Tuberculosis (TB) is the infectious disease that kills the most people worldwide
The World Health Organization (WHO) launched the ‘End TB’ strategy in 2014, aiming to achieve the elimination of TB by 2050 (< 1 case per 100,000 people), and to reduce TB mortality by 95% by 2035; both goals are a large challenge in developing countries, such as Brazil [2]
Usingk the traditional scan, for low rates and 10% of the population exposed, a protection cluster was identified in the northwestern region of the municipality, where there were no deaths due to TB, whereas for 30 and 50% of the population at risk, the protection cluster involved the entire southern region of the municipality, with 5 deaths for each cluster
Summary
Tuberculosis (TB) is the infectious disease that kills the most people worldwide. Tuberculosis (TB) is an ancient disease that remains a serious public health problem worldwide, affecting 30 countries that account for 87% of TB cases. The disease is among the infectious disease that kills the most people worldwide, more than HIV and malaria [1]. The World Health Organization (WHO) launched the ‘End TB’ strategy in 2014, aiming to achieve the elimination of TB by 2050 (< 1 case per 100,000 people), and to reduce TB mortality by 95% by 2035; both goals are a large challenge in developing countries, such as Brazil [2]. The ‘Brazil free of tuberculosis’ strategy was adopted, which aims to improve access to diagnosis and quality treatment in order to achieve the goals defined by the WHO [2]. The strategy is based on three pillars: integrated and patient-centred prevention and care; bold policies and supportive systems; and the intensification of research and innovation [3]
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