Space-time analysis of pulmonary tuberculosis hospitalizations in mainland Portugal (2002-2016)

Abstract

Abstract Background Tuberculosis (TB) imposes a great pressure on healthcare resources, particularly in terms of hospital-based treatment and extended hospitalization. Understanding the space-time clustering of pulmonary TB (PTB) hospitalizations leads to a richer knowledge to assist decision makers in Public Health to develop strategic interventions to reduce these hospitalizations. Our objective was to identify space-time clusters of PTB hospitalizations at municipality level in mainland Portugal. Methods Ecologic study using data from nationwide hospitalization database of Portugal. All patients with a diagnosis of PTB (primary or secondary) and reference to place of residence were included in the study (n = 22760). Space-time analysis was used to define clusters with high rates of hospitalizations at the municipality level between 2002 and 2016. Results Overall hospitalization rate was 17.7/105population/year, with hospitalization rates decreasing by 64.9% during this period (2002:29.4/105; 2016:9.6/105). Space-time analysis of the overall period identified five different clusters, with the clusters in Lisboa and Porto metropolitan areas presenting the highest hospitalization rates (51.5/105 and 43.6/105population, respectively). In a more recent period (2011-2016), were identified four clusters with Lisboa metropolitan area and a northeast rural region presenting the highest hospitalization rates (27.6/105 and 46.2/105population, respectively). Conclusions PTB hospitalization rates in continental Portugal presented a constant decrease between 2002 and 2016. We identified a cluster of PTB hospitalizations in a rural region of northeast mainland Portugal, an area where the incidence of TB is below 20/105population. A closer look is needed to understand the reasons behind this high number of hospitalizations. Our results show that space-time analysis can be a resource to monitor the dynamic of the disease and identify possible areas needing Public Health intervention. Key messages Pulmonary tuberculosis hospitalizations are decreasing in mainland Portugal, with the two major urban areas (Lisboa and Porto) presenting the clusters with highest hospitalization rates. A cluster of hospitalizations for pulmonary tuberculosis was identified in a rural region in the northeast of mainland Portugal, an area with a low incidence of tuberculosis.