Temporal trends in areas at risk for concomitant tuberculosis in a hyperendemic municipality in the Amazon region of Brazil

Alexandre Tadashi Inomata Bruce,Pedro Fredemir Palha,Juliane De Almeida Crispim,Ione Carvalho Pinto,Luiz Henrique Arroyo,Felipe Lima Dos Santos,Thais Zamboni Berra,Dulce Maria De Oliveira Gomes,Ana Carolina Scarpel Moncaio,Antônio Carlos Vieira Ramos,Ludmilla Leidianne Limirio Souza,Aline Aparecida Monroe,Mellina Yamamura,Ricardo Alexandre Arcêncio,Regina Célia Fiorati,Yan Mathias Alves

doi:10.1186/s40249-020-00732-0

Abstract

BackgroundAlthough preventable and curable, tuberculosis (TB) still occurs in poor or developing countries, mainly in metropolitan regions of larger cities. The disease is a serious public health problem, and is directly linked to social issues. We analyzed temporal trend variations in areas at risk for concomitant TB, and characterized the clinical and epidemiological profiles of cases in a hyperendemic municipality in the Amazon region of Brazil.MethodsThis ecological study was performed in the municipality of Manaus, in northern Brazil. The population comprised cases with concomitant pulmonary and extrapulmonary TB, registered on the Notifiable Diseases Information System (SINAN), between January 1, 2009 and December 31, 2018. For risk cluster detection, spatial and spatiotemporal scanning statistical techniques were used. The Spatial Variation in Temporal Trends (SVTT) approach was used to detect and infer clusters for significantly different time trends.ResultsBetween 2009 and 2018, 873 concomitant TB cases were registered in Manaus. By using purely spatial scanning statistics, we identified two risk clusters. The relative risk (RR) of the clusters was 2.21 (95% confidence interval [CI]: 1.57–2.88; P = 0.0031) and 2.03 (95% CI: 1.58–2.58; P = 0.0029). Using space-time scanning, we identified a risk cluster with an RR of 3.57 (95% CI: 2.84–4.41; P = 0.014), between 2017 and 2018. For SVTT analyses, three clusters with spatial variations were detected in the significant temporal trends: SVTT 1 (P = 0.042), SVTT 2 (P = 0.046) and SVTT 3 (P = 0.036).ConclusionsIn Brazil, several TB-determining factors such as race/color, gender, low educational level and low income overlap in needy urban areas and communities, demonstrating that it is unlikely to reach the goals, agreed and launched with the END TB Strategy within the deadlines of international agreements, if there is no reduction in existing inequities determinants and risk of illness in the country.

Highlights

IntroductionTuberculosis (TB) still occurs in poor or developing countries, mainly in metropolitan regions of larger cities
Preventable and curable, tuberculosis (TB) still occurs in poor or developing countries, mainly in metropolitan regions of larger cities
The results indicated an Internal Temporal Trend (ITT), which consisted of the degree of growth or decrease of the event within the cluster, and an External Temporal Trend (ETT), which corresponded to the trend of all other areas that do not belong to this cluster in question

Summary

Introduction

Tuberculosis (TB) still occurs in poor or developing countries, mainly in metropolitan regions of larger cities. The disease is a serious public health problem, and is directly linked to social issues. Many TB cases are registered in poor or developing countries, mainly in metropolitan regions of large cities as such, the disease is considered a serious public health problem, directly linked to social issues [1]. 85% of registered TB cases are pulmonary, due to a predilection of the Bacillus for the lungs, other parts of the body are affected [3]. Apart from the lungs, other organs are often affected These concomitant pulmonary or extrapulmonary TB conditions are more difficult to cure [4, 5]

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