A endemia de tuberculose e seus determinantes socioeconômicos no Espírito Santo : uma análise de dados espaciais
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Data
2006-12-14
Autores
Vieira, Rafael da Cruz Araújo
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Universidade Federal do Espírito Santo
Resumo
Tuberculosis is the main cause of deaths among adults around the world by infectious illnesses, still today. Every year 8,8 million new cases are recorded and the disease is responsible for about 2,7 million deaths. Individualized strategies like early diagnosis and effective treatment not produced the results expected. Studies suggest Spatial Data Analysis can contribute to the design focused actions on health and to learn more about occurrence and determinants of disease. The objectives of this study were to characterize socio-economic and demographic profiles of Espírito Santo cities, to analyze tuberculosis endemicity and its spatial distribution, and to evaluate relationships among incidence of tuberculosis and socioeconomic and demographic profiles, in the period 2000 to 2004. This was an ecological study, and used census tract data and information from SINAN (National Databank of Major Causes of Morbidity). Cities profiles produced by this study were carried out through multivariate techniques (Factor Analysis and hierarchical clustering methods). The epidemiology of illness was described through tuberculosis crude rates and Age-Standardized, and Global and Local Empirical Bayesian smoothed rates. Spatial Autocorrelation among rates were tested using Moran's I and Local Moran's Index (LISA). Statistical analysis of correlation among tuberculosis endemicity and Socioeconomic and Demographic Indicators was done through ANOVA one-way test for comparison of more than two independent groups. Cities classification provides four greatly diverse socio-economic and demographic profiles. A moderate-to-strong, positive, significant spatial autocorrelation (Moran’s I = 0.585207; p < 0.001) was found in Tuberculosis incidence rates. Furthermore, three clusters according to LISAMAP: the Metropolitan Region of Vitória, the North Region and the Mountainous/Caparaó Region. In two of four cities profiles, incidence rates were significantly superior to the others (F = 15.38; p < 0.000). Tuberculosis endemicity was closely correlated with the Urbanization factor (r = 0.6737; p < 0.05). Socio-economic and demographic classification was able to highlight widely different life conditions among the cities and its inhabits. The occurrence of spatial autocorrelation shows that endemicity could be determined by an underlying process. The correlation between tuberculosis incidence and the Urbanization factor can be explained by a historical process, when it was observed that some attractive regions experienced a fast urbanization process marked by excluding and promoter of huge intra-municipal inequalities. It is suggested that new tuberculosis cases follow heterogeneous distributions inside cities, it tending to a concentrated in poorer regions.