Risk-prone territories for spreading tuberculosis, temporal trends and their determinants in a high burden city from Sao Paulo State, Brazil

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Berra, Thais Zamboni ; Vieira Ramos, Antonio Carlos ; Arroyo, Luiz Henrique ; Delpino, Felipe Mendes ; Crispim, Juliane de Almeida ; Alves, Yan Mathias ; dos Santos, Felipe Lima ; Paulino da Costa, Fernanda Bruzadelli ; dos Santos, Marcio Souza ; Alves, Luana Seles ; Fiorati, Regina Celia ; Monroe, Aline Aparecida ; Gomes, Dulce ; Arcencio, Ricardo Alexandre

• Document type: Journal article
• Source: BMC INFECTIOUS DISEASES; v. 22, n. 1, p. 11-pg., 2022-06-02.

Abstract

Objectives To identify risk-prone areas for the spread of tuberculosis, analyze spatial variation and temporal trends of the disease in these areas and identify their determinants in a high burden city. Methods An ecological study was carried out in Ribeirao Preto, Sao Paulo, Brazil. The population was composed of pulmonary tuberculosis cases reported in the Tuberculosis Patient Control System between 2006 and 2017. Seasonal Trend Decomposition using the Loess decomposition method was used. Spatial and spatiotemporal scanning statistics were applied to identify risk areas. Spatial Variation in Temporal Trends (SVTT) was used to detect risk-prone territories with changes in the temporal trend. Finally, Pearson's Chi-square test was performed to identify factors associated with the epidemiological situation in the municipality. Results Between 2006 and 2017, 1760 cases of pulmonary tuberculosis were reported in the municipality. With spatial scanning, four groups of clusters were identified with relative risks (RR) from 0.19 to 0.52, 1.73, 2.07, and 2.68 to 2.72. With the space-time scan, four clusters were also identified with RR of 0.13 (2008-2013), 1.94 (2010-2015), 2.34 (2006 to 2011), and 2.84 (2014-2017). With the SVTT, a cluster was identified with RR 0.11, an internal time trend of growth (+ 0.09%/year), and an external time trend of decrease (- 0.06%/year). Finally, three risk factors and three protective factors that are associated with the epidemiological situation in the municipality were identified, being: race/brown color (OR: 1.26), without education (OR: 1.71), retired (OR: 1.35), 15 years or more of study (OR: 0.73), not having HIV (OR: 0.55) and not having diabetes (OR: 0.35). Conclusion The importance of using spatial analysis tools in identifying areas that should be prioritized for TB control is highlighted, and greater attention is necessary for individuals who fit the profile indicated as "at risk" for the disease. (AU)

• FAPESP's process: 18/03700-7 - The impact of gene Xpert MTB/RIF in the detection of Tuberculosis and Multidrug-Resistant Tuberculosis and its spatial pattern in Ribeirão Preto-SP
• Grantee: Thaís Zamboni Berra
• Support Opportunities: Scholarships in Brazil - Doctorate