Morbimortalidade por doenças tropicais negligenciadas no estado do Piauí: padrões espaço-temporais e fatores relacionados, 2001–2018

Abstract

Neglected Tropical Diseases (NTDs) are responsible for a high burden of morbidity and mortality in Brazil. Territories endemic and with high social vulnerability in the Northeast region contribute to most of their burden. We aimed to analyse the spatial and spatio-temporal patterns associated with hospital morbidity and mortality from NTDs in the state of Piauí, Northeast region of Brazil, in the period 2001-2018. Ecological studies were conducted, with mixed designs, based on secondary data from Hospital Admission Orders and multiple causes of death (basic and associated) by NTD, in the period 2001-2018, via the Hospital Information System and Mortality Information System. We applied risk ratio (RR) calculation; temporal trend analysis, by segmented linear regression, inflection points (Joinpoints) of the indicators of hospitalizations and deaths; and analysis of overlapping and co-infections by HIV/AIDS. To identify municipalities and health regions at high risk for occurrences of hospitalizations and deaths, spatial and spatio-temporal analysis techniques were applied, according to autocorrelation by spatial moving average rates, local Moran's index, and spatio-temporal scan statistics. NTDs were responsible for 49,832 hospitalizations (rate: 87.8/100,000 inhabitants), repercussing a total cost of R$34,481,815.43 to public health services; and 2,609 deaths (rate: 4.6/100,000) in Piauí, 2001-2018. Dengue was the most recurrent cause, 38,982 (78.2%, rate: 68.7/100,000) for hospitalizations, and Chagas disease, 1,441 (55.2%, rate: 2.5/100,000) for deaths. Higher risks for hospitalizations and deaths, respectively, occurred in: elderly ≥60 years (RR=1.8; 95% Confidence Interval [95%CI]: 1.5;2.2; and RR=40.71; 95%CI: 10.01;165.53); residents in municipalities of medium social vulnerability (RR=1.5, 95%CI: 1.3;1.6; and RR=1.76; 95%CI: 1.09;2.84); of medium (RR=1.6, 95%CI:1. 4;1.9) and low population (RR=1.99; 95%CI: 1.28;3.10); and belonging to the health macroregions Mid North (RR= 9.1, 95%CI: 8.2;10.1) and Cerrados (RR=4.51; 95%CI: 2.51;8.11). There were trends of reduction (APC= -10.3; 95%CI: -14.7;-5.6) for hospitalizations from 2003 to 2018; increase (APC= 7.9; 95%CI: 3.1;12.9) from 2001 to 2008, and reduction (APC= -3.1; 95%CI: -5.5;-0.7) from 2008 to 2018 for occurrences of deaths. HIV/AIDS coinfection was associated in 99 causes of NTD deaths, with leishmaniases having 51 (51.5%) cases with the highest frequency. Overlaps with heterogeneous spatial distribution involving 2 NTDs were predominant in 2018, with leishmaniasis and dengue highlighted in 24 municipalities (10.7%), hospitalizations; and Chagas disease and leishmaniasis in 6 (2.7%) municipalities, deaths. High rates and high-risk clusters for hospitalizations were identified in municipalities of the microregions, Guaribas River Valley; and border, Entre Rivers, Sambito Valley, Canindé and Piauí and Itaueira Rivers. For mortality, in the Canindé Valley, Piauí and Itaueira Rivers, Serra da Capivara, and southern Chapada das Mangabeiras. The NTDs are relevant causes of hospitalizations and deaths in Piauí, and contribute to a high burden of morbidity and mortality. Population groups and territories of higher vulnerability were related to higher risks of occurrence. Co-infections by HIV/AIDS, geographic overlaps and areas of high rates and risk for the indicators of hospitalizations and deaths, translate a persistent public health problem and the need for management of integrated, intensified and intersectoral control actions, in addition to expansions of access for accurate diagnosis and timely treatment in endemic municipalities and with difficult access to health services. The study provided evidence that opportunizes the direction and expansion of actions to confront NTDs in the Unified Health System (UHS), to achieve the Sustainable Development Goals (SDGs) by 2030.