Spatiotemporal pattern of the incidence of tuberculosis and associated factors

Ecological study, which used tuberculosis notifications during 2001-2017 and as units of analysis the municipalities of the state of Ceará of the Notifiable Diseases Information System. Time pattern analysis techniques and geographically weighted regression were used.

Results:

The gross incidence rate in the state reached a peak of 226.1/100 thousand inhabitants with a significant decrease of 1.9% per year (95%CI −3.0–−0.7). The main clusters were identified in Fortaleza and its metropolitan region, as well as in the Sobral region. The socioeconomic indicators that were associated with the incidence were: occupation in the agricultural sector and services, population in households with bathrooms and running water and vulnerable to poverty.

Conclusion:

There was a significant decrease in the incidence of the disease in the state of Ceará. The spatial clusters were mostly located in areas with high population and the indicators most related to the formation of spatial clusters were related to employment/income, housing and vulnerability.

Keywords:
Tuberculosis; Incidence; Spatial analysis; Epidemiology

Sociodemographic characteristics		n	%
Age (median)		38	25–52
Gender^* * 14 cases;
	Male	37,649	62.1
	Female	22,951	37.9
Race/color^† † 8,217 cases;
	Caucasian/White	8,768	16.7
	Black	3,941	7.5
	Yellow	617	1.2
	Brown	38,859	74.2
	Indigenous	212	0.4
Education^‡ ‡ 17,112 cases;
	Illiterate	7,785	17.9
	Incomplete elementary school	9,899	22.7
	Complete elementary school	2,947	6.8
	Incomplete middle school/high school	10,952	25.2
	Complete middle school/high school	2,518	5.8
	Incomplete High school	4,440	10.2
	Complete High school	3,220	7.4
	Incomplete Higher education	456	1.0
	Comeplte Higher education	1,285	3.0
Are of residence^§ § 1,970 cases.
	Urban	49,134	84.1
	Rural	9,113	15.5
	Periurban	397	0.4

Cluster	Cluster radius	Number of municipalities	Population	Likelihood ratio	Relative risk	p-value
1	28.30 km	6	953,316	7,659.01	2.75	<0.001
2	0 km	1	61,676	633.70	2.15	<0.001
3	10.88 km	2	23,728	29.78	1.36	<0.001
4	0 km	1	4,151	9.58	1.49	0.01

Socioeconomic indicators	OLS model^* * OLS: ordinary least squares;			GWR model^† † GWR: geographically weighted regression.
Socioeconomic indicators	Coefficient	Standard error	p	Coefficient	Standard error
Employed in the agricultural sector (%)	-1.12	0.15	<0.001	-1.08	0.13
Employed in the services sector (%)	-0.6	0.27	0.02	-0.58	0.06
Population in households with a bathroom and running water (%)	0.27	0.12	0.03	0.26	0.08
Population vulnerable to poverty (%)	0.88	0.27	0.002	0.82	0.19

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E-mail: revbrepi@usp.br

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[1] Corresponding author: George Jó Bezerra Sousa – Avenida Dr. Silas Munguba, 1.700, Itaperi, CEP: 60714-903, Fortaleza (CE), Brasil. E-mail: georgejobs@hotmail.com