Spatial distribution of tuberculosis from 2002 to 2012 in a midsize city in Brazil

Abstract

BackgroundTuberculosis (TB) remains a major public health problem in many developing countries. Exploratory spatial analysis is a powerful instrument in spatial health research by virtue of its capacity to map disease distribution and associated risk factors at the population level. The aim of the present study was to describe the epidemiologic characteristics and spatial distribution of new cases of TB reported during the period 2002–2012 in Divinopolis, a midsized city located in the state of Minas Gerais, southeastern Brazil.MethodsSociodemographic and clinical data relating to the study cases were retrieved from the national Brazilian database and geocoded according to residential address. Choropleth and kernel density maps were constructed and a spatial-temporal analysis was performed. Tracts defined by the 2010 national census were classified as sectors with higher or lower densities of new TB cases based on the kernel density map. Multivariate logistic analysis was used to compare the two types of sectors according to income, level of literacy and population density.ResultsA total of 326 new cases of TB were reported during the study period. Residential addresses relating to 309 (94.8 %) of these were available in the SINAN database and the locations were geocoded and mapped. The average incidence of TB during the study period was 14.5/100,000 inhabitants. Pulmonary TB was the most predominant form (73.6 %) and 74.5 % of patients had been cured. The percentage of cases was highest in males (67.8 %) and individuals aged 25–44 years (41.1 %), and lowest in children aged less than 15 years (4.6 %). The disease was spatially distributed throughout the urban district. The incidence rate among urban census tracts ranged from 0.06 to 1.1 %, and the disease occurred predominantly in the downtown area (99.3 %). Higher population density was associated significantly with increased odds of living in a sector with a “higher density of cases”, even after adjusting for income and education (odds ratio = 13.7).ConclusionsThe highest density of cases was strongly associated with higher population density but not with lower income or level of literacy.

A new combination rule for Spatial Decision Support Systems for epidemiology

“…The research of [56] stated that the spatial distribution of TB was more concentrated in neighborhoods with higher population and intradomiciliary densities, corroborating the results of the present study. Another study found that TB occurred predominantly in the central region of Divinópolis, Minas Gerais, Brazil, and a significant association can be found between the disease and the sites with the highest population density [49], similarly to the findings of this work. In a study conducted in Fortaleza, Brazil, it was found that TB cases were agglomerated in areas with high informal settlement rates [57].…”

“…Accordingly, the rules that make up each rule-based fuzzy system within each SDSS should also be changed. Studies show that TB is more frequent in males individuals [46–49], perhaps as a result of men being more prone to alcoholism, malnourishment or co-infection with the HIV virus [50]. Regarding the educational level, investigations show association of TB with illiteracy and low level of schooling [50, 51].…”

Epidemiological and spatial factors for tuberculosis: a matched case-control study in Nagata, Japan

“…Previous studies showed that serum albumin level, high population density and healthcare worker were associated with TB. 20,21,22 Those results may be due to malnutrition, higher exposure to TB patients and overcrowding. However, those results could also be related to any potential bias, such as selection bias.…”

Tuberculosis Dynamics From Spatial Analysis: Integrative Review

“…9 Relations evidenced by the inverse association between the socioeconomic status and TB incidence, relation between vulnerability, socioeconomic and sociodemographic condition, mortality and coinfection by HIV-TB. [10][11][12][13][14][15][16][17][18][19][20][21] The vulnerability was also observed among indigenous people, in the data of child mortality due to HIV-TB coinfection, being 3 times higher in orphan children, along with in the difficult adherence to the TB treatment and poor living conditions of people subjected to such circumstances. [22][23][24]…”