Space–Time Clustering and Socioeconomic Factors Associated with Mortality from Diarrhea in Alagoas, Northeastern Brazil: A 20-Year Population-Based Study

Abstract

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.

Spatiotemporal analysis of diarrhea-related hospitalizations of children in Brazil’s Midwest region from 2011 to 2020

“…For this reason, the better conditions for preventing diarrhea reflected by the higher HDIs have probably contributed to low-risk clusters of hospitalization for the disease. This contrasts with the setting identified in Alagoas state (which has the worst HDI) 39 for mortality rates of diarrhea for both age groups from 2011 to 2020 ( ).…”

Socioeconomic Inequalities, Water, Sanitation, Hygiene and Diarrheal Disease Among Children Under Five Years in Indonesia

“…Socioeconomic status was one of the main causes of diarrheal diseases among children in China (15). A study also found that the diarrheal diseases are still a crucial public health, especially in the poorest areas (16,17). Poorly populated areas generally have poor waste disposal systems, unclean drinking water sources, and difficulty accessing health services, thereby increasing the incidence of diarrhea and gastrointestinal infections (16).…”