Social determinants of deaths from pneumonia and tuberculosis in children in Brazil: an ecological study
Social determinants of deaths from pneumonia and tuberculosis in children in Brazil: an ecological study
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DOI：
10.1136/bmjopen-2019-034074
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发表时间：
2020-01-01
期刊：
影响因子：
2.9
通讯作者：
Arcencio, Ricardo Alexandre
中科院分区：
文献类型：
--
作者：
Berra, Thais Zamboni;de Assis, Ivaneliza Simionato;Arcencio, Ricardo Alexandre
目的确定未指明的儿童肺炎和结核病（TB）死亡的危险区域，并确定这些事件与较高的结核病发病率和社会决定因素之间是否存在关系。方法在巴西进行生态学研究。2006年至2016年期间报告的所有5岁以下儿童结核病或未指明肺炎死亡病例均通过统一卫生系统信息部（巴西电子数据库）纳入和收集。空间扫描统计被用来确定死亡风险较高的地区。通过Getis-Ord技术验证了空间关联。利用二元Moran全球指数（Bivariate Moran Global Index）验证了两个事件之间的空间自相关性。为了确定结核病和肺炎死亡与肺结核流行地区和社会决定因素的关系，确定了四种解释性统计模型。结果共检出肺炎21 391例，结核238例。空间扫描分析能够检测到4个结核病风险集群（相对风险RR在3.30 ~ 18.18之间）和22个肺炎风险集群（RR在1.38 ~ 5.24之间）。事件的空间相关性（z-score分别为3.74和64.34）和事件之间的空间自相关性（Moran Index:0.031 (p=0.001)）得到证实。选择零膨胀负二项分布，并确定了这两种事件与结核病发病率（OR 5.3, 95% CI 2.85至9.84;OR 6.63, 95% CI 5.62至7.81）和基尼指数（OR 1.78, 95% CI 1.12至2.82;OR 4.22, 95% CI 3.63至4.92）的关联。初级保健覆盖率显示肺炎与这两种事件呈负相关（OR 0.10, 95% CI 0.67至0.17;OR 0.18, 95% CI 0.15至0.21）。最后，受益于家庭补助计划的家庭与肺炎死亡呈负相关（OR 0.81, 95% CI 0.52 - 1.25）。研究结果不仅有助于降低儿童死亡率，而且主要有助于通过确定巴西的关键地区来预防过早死亡，这对合格的卫生监测服务至关重要。
Objective To identify the risk areas of deaths due to unspecified pneumonia and tuberculosis (TB) in children, and to identify if there is a relationship between these events with higher TB incidence and social determinants. Methods Ecological study carried out in Brazil. All cases of TB or unspecified pneumonia deaths in children under 5 years of age reported between 2006 and 2016 were included and collected through Department of Informatics of the Unified Health System (Brazil's electronic database). The Spatial Scan Statistics was used to identify areas at higher risk of dying from this event. The spatial association was verified through the Getis-Ord techniques. The Bivariate Moran Global Index was used to verify the spatial autocorrelation between the two events. To identify the association of TB and pneumonia deaths with endemic areas of pulmonary TB and social determinants, four explanatory statistical models were identified. Results A total of 21 391 cases of pneumonia and 238 cases of TB were identified. Spatial scanning analysis enabled the detection of four clusters of risk for TB (relative risk, RR, between 3.30 and 18.18) and 22 clusters for pneumonia (RR between 1.38 and 5.24). The spatial association of the events was confirmed (z-score 3.74 and 64.34) and spatial autocorrelation between events (Moran Index:0.031 (p=0.001)). The zero-inflated negative binomial distribution was chosen, and an association for both events was identified with the TB incidence rate (OR 5.3, 95% CI 2.85 to 9.84; OR 6.63, 95% CI 5.62 to 7.81), with the Gini Index (OR 1.78, 95% CI 1.12 to 2.82; OR 4.22, 95% CI 3.63 to4.92). Primary care coverage showed an inverse association for both events (OR 0.10, 95% CI 0.67 to 0.17; OR 0.18, 95% CI 0.15 to 0.21) for pneumonia). Finally, a family that benefited from the Bolsa Familia Programme had an inverse association for deaths from pneumonia (OR 0.81, 95% CI 0.52 to 1.25). Conclusions The results do not just contribute to reduce mortality in children, but mainly contribute to prevent premature deaths through identification of critical areas in Brazil, which is crucial to qualify health surveillance services.