Risk-prone territories for spreading tuberculosis, temporal trends and their determinants in a high burden city from São Paulo State, Brazil.
Thaís Zamboni Berra, Antônio Carlos Vieira Ramos, Luiz Henrique Arroyo, Felipe Mendes Delpino, Juliane de Almeida Crispim, Yan Mathias Alves, Felipe Lima Dos Santos, Fernanda Bruzadelli Paulino da Costa, Márcio Souza Dos Santos, Luana Seles Alves, Regina Célia Fiorati, Aline Aparecida Monroe, Dulce Gomes, Ricardo Alexandre Arcêncio
Author Information
Thaís Zamboni Berra: Department of Maternal-Infant and Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil. thaiszamboni@live.com.
Antônio Carlos Vieira Ramos: Department of Maternal-Infant and Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil.
Luiz Henrique Arroyo: Department of Maternal-Infant and Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil.
Felipe Mendes Delpino: Department of Maternal-Infant and Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil.
Juliane de Almeida Crispim: Department of Maternal-Infant and Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil.
Yan Mathias Alves: Department of Maternal-Infant and Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil.
Felipe Lima Dos Santos: Department of Maternal-Infant and Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil.
Fernanda Bruzadelli Paulino da Costa: Department of Maternal-Infant and Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil.
Márcio Souza Dos Santos: Department of Maternal-Infant and Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil.
Luana Seles Alves: Department of Maternal-Infant and Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil.
Regina Célia Fiorati: Department of Neurosciences and Behavioral Sciences, Faculty of Medicine, University of São Paulo at Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil.
Aline Aparecida Monroe: Department of Maternal-Infant and Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil.
Dulce Gomes: Mathematics Department, University of Évora, Rua Romão Ramalho, 59, Évora, Portugal.
Ricardo Alexandre Arcêncio: Department of Maternal-Infant and Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil.
OBJECTIVES: To identify risk-prone areas for the spread of tuberculosis, analyze spatial variation and temporal trends of the disease in these areas and identify their determinants in a high burden city. METHODS: An ecological study was carried out in Ribeirão Preto, São Paulo, Brazil. The population was composed of pulmonary tuberculosis cases reported in the Tuberculosis Patient Control System between 2006 and 2017. Seasonal Trend Decomposition using the Loess decomposition method was used. Spatial and spatiotemporal scanning statistics were applied to identify risk areas. Spatial Variation in Temporal Trends (SVTT) was used to detect risk-prone territories with changes in the temporal trend. Finally, Pearson's Chi-square test was performed to identify factors associated with the epidemiological situation in the municipality. RESULTS: Between 2006 and 2017, 1760 cases of pulmonary tuberculosis were reported in the municipality. With spatial scanning, four groups of clusters were identified with relative risks (RR) from 0.19 to 0.52, 1.73, 2.07, and 2.68 to 2.72. With the space-time scan, four clusters were also identified with RR of 0.13 (2008-2013), 1.94 (2010-2015), 2.34 (2006 to 2011), and 2.84 (2014-2017). With the SVTT, a cluster was identified with RR 0.11, an internal time trend of growth (+ 0.09%/year), and an external time trend of decrease (- 0.06%/year). Finally, three risk factors and three protective factors that are associated with the epidemiological situation in the municipality were identified, being: race/brown color (OR: 1.26), without education (OR: 1.71), retired (OR: 1.35), 15 years or more of study (OR: 0.73), not having HIV (OR: 0.55) and not having diabetes (OR: 0.35). CONCLUSION: The importance of using spatial analysis tools in identifying areas that should be prioritized for TB control is highlighted, and greater attention is necessary for individuals who fit the profile indicated as "at risk" for the disease.
