Mortalidade por doenças tropicais negligenciadas no Piauí, Nordeste do Brasil: tendência temporal e padrões espaciais, 2001-2018

Objective: To analyze temporal trends and spatial patterns of mortality from neglected tropical diseases (NTD) in Piauí, 2001-2018. Methods: Mixed ecological study, with hazard ratio (RR) calculation,spatio- temporal trend analysis, Poisson regression with inflection points, using data from the Mortality Information System. Results: There were 2,609 deaths due to NTD in the period (4.60/100,000 inhabitants), 55.2% due to Chagas disease. There was a higher risk of death in men (RR=1.76 – 95%CI 1.25;2.46), aged ≥60 years (RR=40.71 – 95%CI 10.01;165.53), municipalities with vulnerability average social (RR=1.76 – 95%CI 1.09;2.84), smaller population size (RR=1.99 – 95%CI 1.28;3.10) and Cerrados macro-region (RR=4.51-95%CI 2.51;8.11). There was an upward trend in mortality rates from 2001-2008 and a reduction from 2009- 2018. Conclusion: Mortality due to NTD in Piauí remains high, particularly due to Chagas disease, among groups with greater vulnerability, with concentration of higher rates in the southwest of the semi-arid macro-region, northeast and south of the Cerrados.Objetivo: Analizar las tendencias temporales y patrones espaciales de mortalidad por enfermedades tropicales desatendidas (ETD) en Piauí, 2001-2018. Métodos: Estudio ecológico mixto, con cálculo de hazard ratio (RR), análisis de tendencias espacio-temporales, regresión de Poisson con puntos de inflexión, utilizando datos del Sistema de Información de Mortalidad. Resultados: Hubo 2.609 defunciones por ETD en el período (4,60/100.000 habitantes), 55,2% por enfermedad de Chagas. Hubo un mayor riesgo de muerte en hombres (RR=1,76 – IC95% 1,25;2,46), edad ≥60 años (RR=40,71 – IC95% 10,01;165,53), municipios con vulnerabilidad social media (RR=1,76 – IC95% 1,09;2,84), tamaño de población más pequeño (RR=1,99 – IC95% 1,28;3,10) y macrorregión de Cerrados (RR=4,51 – IC95% 2,51;8,11). Hubo tendencia al alza en las tasas de mortalidad de 2001-2008 y  reducción de 2009-2018. Conclusión: La mortalidad por ETD en Piauí sigue siendo alta, particularmente por la enfermedad de Chagas, entre los grupos con mayor vulnerabilidad, con concentración de tasas más altas en el suroeste de la macrorregión semiárida, noreste y sur de los Cerrados.Objetivo: Analisar tendência temporal e padrões espaciais da mortalidade por doenças tropicais negligenciadas (DTNs) no Piauí, Brasil, 2001-2018. Métodos: Estudo ecológico misto, com cálculo de razão de risco (RR), análise de tendência  espaço-temporal e regressão de Poisson com pontos de inflexão, utilizando-se dados do Sistema de Informações sobre Mortalidade. Resultados: Verificou-se 2.609 óbitos por DTNs no período (4,60/100 mil habitantes), 55,2% por doença de Chagas. Houve maior risco de morte em homens (RR=1,76 –IC95% 1,25;2,46), idade ≥60 anos (RR=40,71 –IC95% 10,01;165,53), municípios com vulnerabilidade social média (RR=1,76 – IC95% 31,09;2,84), menor porte populacional (RR=1,99 – IC95% 1,28;3,10) e macrorregião dos Cerrados (RR=4,51 – IC95% 2,51;8,11). Verificou-se tendência de aumento nas taxas de mortalidade em 2001-2008 e redução em 2009-2018. Conclusão: A mortalidade por DTNs no Piauí persiste elevada, particularmente por doença de Chagas, entre grupos de maior vulnerabilidade, concentrando-se as maiores taxas no sudoeste da macrorregião do Semiárido, nordeste e sul dos Cerrados

Mortality and case fatality due to visceral leishmaniasis in Brazil: a nationwide analysis of epidemiology, trends and spatial patterns

Background: visceral leishmaniasis (VL) is a significant public health problem in Brazil and several regions of the world. This study investigated the magnitude, temporal trends and spatial distribution of mortality related to VL in Brazil.\ud \ud Methods: we performed a study based on secondary data obtained from the Brazilian Mortality Information System. We included all deaths in Brazil from 2000 to 2011, in which VL was recorded as cause of death. We present epidemiological characteristics, trend analysis of mortality and case fatality rates by joinpoint regression models, and spatial analysis using municipalities as geographical units of analysis.\ud \ud Results: in the study period, 12,491,280 deaths were recorded in Brazil. VL was mentioned in 3,322 (0.03%) deaths. Average annual age-adjusted mortality rate was 0.15 deaths per 100,000 inhabitants and case fatality rate 8.1%. Highest mortality rates were observed in males (0.19 deaths/100,000 inhabitants), <1 year-olds (1.03 deaths/100,000 inhabitants) and residents in Northeast region (0.30 deaths/100,000 inhabitants). Highest case fatality rates were observed in males (8.8%), ≥70 year-olds (43.8%) and residents in South region (17.7%). Mortality and case fatality rates showed a significant increase in Brazil over the period, with different patterns between regions: increasing mortality rates in the North (Annual Percent Change – APC: 9.4%; 95% confidence interval – CI: 5.3 to 13.6), and Southeast (APC: 8.1%; 95% CI: 2.6 to 13.9); and increasing case fatality rates in the Northeast (APC: 4.0%; 95% CI: 0.8 to 7.4). Spatial analysis identified a major cluster of high mortality encompassing a wide geographic range in North and Northeast Brazil.\ud \ud Conclusions: despite ongoing control strategies, mortality related to VL in Brazil is increasing. Mortality and case fatality vary considerably between regions, and surveillance and control measures should be prioritized in high-risk clusters. Early diagnosis and treatment are fundamental strategies for reducing case fatality of VL in Brazil

Fatores associados à insegurança alimentar em pessoas que vivem com HIV/AIDS

Objective: To analyze factors associated with food insecurity in people living with HIV/AIDS. Methods: Cross-sectional study carried out with 205 patients treated, from December 2016 to April 2017, at a referral hospital in infectious diseases in the state of Ceará. The study collected socioeconomic (income, occupation, housing conditions, schooling), demographic (sex, age, marital status), and anthropometric (weight and height) data, along with data on habits (use of alcohol, drugs and practice of physical activity) and food safety. Food insecurity was evaluated through the Brazilian Food Insecurity Scale, and its associations, with use of Pearson’s chi-square test and prevalence ratio. Results: Out of 205 patients, 68.3% (n=140) were men; 56.1% (n=115) were 39 to 58 years old; 61% (n=125) were single; 60% (n=124) were unemployed; 49.8% (n=102) had income lower than 1½ minimum wage; 38.5% (n=79) had studied only up to middle school; 47.3% (n=97) were overweight; 70.7% (n=145) lived with 4 or fewer people; 79.5% (n=163) did not use alcohol; 87.3% (n=179) did not use drugs, and 64.4% (n=132) did not practice any physical activity. Food insecurity was 47.3% (n=97). Of these, 10.7% (n=22) were at a serious level. Statistical associations were found between food insecurity and age group (p = 0.009), schooling (p = 0.013), number of people per household (p < 0.001), and monthly household income (p < 0.001). Conclusion: A high prevalence of food insecurity was observed in the sample, and it was associated with demographic (age) and socioeconomic characteristics (income, schooling and housing conditions).Objetivo: Analizar los factores asociados con la inseguridad alimentaria de personas con el VIH/AIDS. Métodos: Estudio transversal realizado con 205 pacientes asistidos entre diciembre de 2016 y abril de 2017 en un hospital de referencia en enfermedades infecciosas del estado de Ceará. Se recogieron los datos socioeconómicos (renta, ocupación, condiciones de vivienda, escolaridad), demográficos (sexo, edad, estado civil), antropométricos (peso y altura), sobre los hábitos (uso del alcohol, drogas y prácticas de actividad física) y de seguridad alimentaria. Se evaluó la inseguridad alimentaria a través de la Escala Brasileña de Inseguridad Alimentaria y sus asociaciones a través de la prueba Chi-cuadrado de Pearson y la razón de prevalencia. Resultados: Del total de 205 pacientes, el 68,3% (n=140) eran hombres; el 56,1% (n=115) tenían entre 39 y 58 años; el 61%, (n=125) eran solteros; el 60% (n=124) sin trabajo; el 49,8% (n=102) tenían renta inferior a 1 y ½ sueldo mínimo; el 38,5% (n=79) tenían solamente la educación primaria; el 47,3% (n=97) tenían sobrepeso; el 70,7% (n=145) vivían con 4 personas o menos; el 79,5% (n=163) no consumían el alcohol; el 87,3% (n=179) no usaban drogas y el 64,4% (n=132) no practicaban actividad física. La inseguridad alimentaria ha sido del 47,3% (n=97). De eses, el 10,7% (n=22) estaban con el nivel grave. Se encontró asociaciones estadísticas entre la inseguridad alimentaria y la franja de edad (p = 0,009), la escolaridad (p = 0,013), el número de personas por domicilio (p < 0,001) y la renta mensual del domicilio (p < 0,001). Conclusión: Se observó elevada prevalencia de inseguridad alimentaria en la muestra que estuvo asociada con las características demográficas (edad) y socioeconómicas (renta, escolaridad y condiciones de vivienda).Objetivo: Analisar fatores associados à insegurança alimentar em pessoas que vivem com HIV/AIDS. Métodos: Estudo transversal, realizado com 205 pacientes atendidos, de dezembro de 2016 a abril de 2017, em um hospital de referência em doenças infecciosas do estado do Ceará. Foram coletados dados socioeconômicos (renda, ocupação, condições de residência, escolaridade), demográficos (sexo, idade, estado civil), antropométricos (peso e altura), sobre hábitos (uso de álcool, drogas e práticas de atividade física) e de segurança alimentar. Avaliou-se a insegurança alimentar por meio da Escala Brasileira de Insegurança Alimentar, e as suas associações, através do teste qui-quadrado de Pearson e razão de prevalência. Resultados: Do total de 205 pacientes, 68,3% (n=140) eram homens; 56,1% (n=115) tinham de 39 a 58 anos; 61%, (n=125) estavam solteiros; 60% (n=124) não estavam empregados; 49,8% (n=102) possuíam renda inferior a 1 e ½ salário-mínimo; 38,5 % (n=79) possuíam apenas nível fundamental; 47,3% (n=97) estavam sobrepesados; 70,7% (n=145) moravam com 04 ou menos pessoas; 79,5% (n=163) não consumiam álcool; 87,3% (n=179) não usavam drogas e 64,4% (n=132) não praticavam atividade física. A insegurança alimentar foi de 47,3% (n=97). Desses, 10,7% (n=22) estavam em nível grave. Encontrou-se associações estatísticas entre insegurança alimentar e faixa etária (p = 0,009), escolaridade (p = 0,013), número de pessoas por domicílio (p < 0,001) e renda mensal domiciliar (p < 0,001). Conclusão: Observou-se alta prevalência de insegurança alimentar na amostra, que esteve associada às características demográficas (idade) e socioeconômicas (renda, escolaridade e condições de moradia)

Mortality related to tuberculosis-HIV/AIDS co-infection in Brazil, 2000-2011: epidemiological patterns and time trends

Abstract: Co-infection of tuberculosis (TB)-HIV/AIDS is a persistent public health problem in Brazil. This study describes epidemiological patterns and time trends of mortality related to TB-HIV/AIDS co-infection. Based on mortality data from 2000-2011 (almost 12.5 million deaths), 19,815 deaths related to co-infection were analyzed. The average age-adjusted mortality rate was 0.97 deaths/100,000 inhabitants. The highest mortality rates were found among males, those in economically productive age groups, black race/color and residents of the South region. There was a significant reduction in the mortality coefficient at the national level (annual average percent change: -1.7%; 95%CI: -2.4; -1.0), with different patterns among regions: increases in the North, Northeast and Central regions, a reduction in the Southeast and a stabilization in the South. The strategic integration of TB-HIV/AIDS control programmes is fundamental to reduce the burden of mortality related to co-infection in Brazil

Moran maps of average annual mortality rates related to VL by municipalities of residence, Brazil, 2000–2011.

<p>Moran maps of average annual mortality rates related to VL by municipalities of residence, Brazil, 2000–2011.</p

Epidemiologic characteristics of deaths related to VL in Brazil, 2000–2011 (n = 3,322).

a<p>Data not available in all cases (age group: 10, race/color: 423, education level: 1,588, marital status: 1,029, and place of occurrence: 9).</p>b<p>Rondônia, Amazonas, Roraima, Amapá, Rio Grande do Norte, Paraíba, Alagoas, Sergipe, Espírito Santo, Rio de Janeiro, Paraná, Rio Grande do Sul, Mato Grosso, Goiás, and Distrito Federal.</p><p>95% CI: 95% confidence intervals.</p