Antivenom access impacts severity of Brazilian snakebite envenoming: A geographic information system analysis.
Antivenom access impacts severity of Brazilian snakebite envenoming: A geographic information system analysis.
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DOI：
10.1371/journal.pntd.0011305
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发表时间：
2023-06
影响因子：
3.8
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中科院分区：
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蛇咬伤（SBE）是一种被忽视的热带疾病，能够导致严重残疾和死亡。在低收入和中等收入国家，SBE 的负担尤其沉重。本研究的目的是进行地理空间分析，评估社会人口统计学与巴西中度和重度 SBE 病例获得护理指标的关联。我们使用开放获取的国家法定传染病识别系统 (SINAN) 数据库，对 2014 年至 2019 年巴西的 SBE 进行了生态、横断面研究。然后，我们从 2010 年巴西人口普查中收集了一组指标，并进行了主成分分析，以创建与健康、经济、职业、教育、基础设施和获得医疗服务相关的变量。接下来，进行描述性和探索性空间分析，以评估中度和严重事件的地理空间关联。使用地理加权泊松回归评估与事件相关的这些变量。 T 值绘制在等值线图上，当值 <-1.96 或 >+1.96 时被认为具有统计显着性。我们发现，北部地区的人口SBE病例数最高（47.83/10万），死亡率最高（0.18/10万），中重度发病率最高（22.96/10万），以及需要三个小时以上才能获得医疗救助的病例比例最高（44.11%）。东北部和中西部的指标排名第二差。预期寿命、年轻人口结构、不平等、电力、职业和三个多小时才能到达医疗中心与中度和严重事件的发生率呈正相关，而收入、文盲率、卫生设施和获得护理的机会则呈负相关。其余指标在该国某些地区呈正相关，在其他地区呈负相关。巴西 SBE 发生率和不良结果率存在地区差异，北部地区受影响尤为严重。多项指标与中度和重度事件发生率相关，例如社会人口统计和医疗保健指标。任何改善蛇咬伤护理的方法都必须确保抗蛇毒血清注射的及时性。
Snakebite envenoming (SBE) is a neglected tropical disease capable of causing both significant disability and death. The burden of SBE is especially high in low- and middle-income countries. The aim of this study was to perform a geospatial analysis evaluating the association of sociodemographics and access to care indicators on moderate and severe cases of SBE in Brazil. We conducted an ecological, cross-sectional study of SBE in Brazil from 2014 to 2019 using the open access National System Identification of Notifiable Diseases (SINAN) database. We then collected a set of indicators from the Brazil Census of 2010 and performed a Principal Component Analysis to create variables related to health, economics, occupation, education, infrastructure, and access to care. Next, a descriptive and exploratory spatial analysis was conducted to evaluate the geospatial association of moderate and severe events. These variables related to events were evaluated using Geographically Weighted Poisson Regression. T-values were plotted in choropleth maps and considered statistically significant when values were <-1.96 or >+1.96. We found that the North region had the highest number of SBE cases by population (47.83/100,000), death rates (0.18/100,000), moderate and severe rates (22.96/100,000), and proportion of cases that took more than three hours to reach healthcare assistance (44.11%). The Northeast and Midwest had the next poorest indicators. Life expectancy, young population structure, inequality, electricity, occupation, and more than three hours to reach healthcare were positively associated with greater cases of moderate and severe events, while income, illiteracy, sanitation, and access to care were negatively associated. The remaining indicators showed a positive association in some areas of the country and a negative association in other areas. Regional disparities in SBE incidence and rates of poor outcomes exist in Brazil, with the North region disproportionately affected. Multiple indicators were associated with rates of moderate and severe events, such as sociodemographic and health care indicators. Any approach to improving snakebite care must work to ensure the timeliness of antivenom administration.