RESUMO
The aim of this study is to analyze the spatiotemporal risk of congenital syphilis (CS) in high-prevalence areas in the city of São Paulo, SP, Brazil, and to evaluate its relationship with socioeconomic, demographic, and environmental variables. An ecological study was conducted based on secondary CS data with spatiotemporal components collected from 310 areas between 2010 and 2016. The data were modeled in a Bayesian context using the integrated nested Laplace approximation (INLA) method. Risk maps showed an increasing CS trend over time and highlighted the areas that presented the highest and lowest risk in each year. The model showed that the factors positively associated with a higher risk of CS were the Gini index and the proportion of women aged 18-24 years without education or with incomplete primary education, while the factors negatively associated were the proportion of women of childbearing age and the mean per capita income.
Assuntos
Teorema de Bayes , Análise Espaço-Temporal , Sífilis Congênita , Humanos , Brasil/epidemiologia , Sífilis Congênita/epidemiologia , Feminino , Adolescente , Adulto Jovem , Adulto , Fatores de Risco , Gravidez , Fatores Socioeconômicos , Prevalência , Recém-Nascido , Complicações Infecciosas na Gravidez/epidemiologiaRESUMO
Introdução: A sífilis é conhecida desde o século XV como causadora de grande número de mortes, permanecendo como grave problema para a saúde pública. Dados mundiais indicam aproximadamente dois milhões de casos de sífilis em gestante (SG) e, o aumento da incidência da sífilis primária e secundária na população, a baixa qualidade do pré-natal, vem refletindo no aumento da incidência de sífilis congênita (SC). As técnicas de análise espacial e espaço-temporal permitem identificar áreas de alto risco e variáveis associadas à ocorrência dos fenômenos estudados. Objetivos: Realizar revisão integrativa sobre análise espacial e espaço-temporal em SG e SC; descrever sua distribuição no estado de São Paulo; identificar aglomerados espaciais, temporais, espaço-temporais e de variação espacial da tendência temporal destes dois agravos em duas escalas geográficas: municípios do estado de São Paulo e as áreas de ponderação da capital do Estado; e modelar no espaço-tempo a ocorrência dos dois agravos nos municípios em função de variáveis socioeconômicas, demográficas, indicadores de saúde e da qualidade da assistência à saúde. Método: Trata-se de estudo descritivo e ecológico dos casos notificados de SG e SC nos municípios do estado de São Paulo, entre 2010 e 2016. Foram realizadas análises para detecção de aglomerados espaciais, espaço-temporais e de variação espacial das tendências temporais para SG e SC, utilizando-se estatística de varredura. As modelagens dos dois agravos foram realizadas utilizando-se modelos Bayesianos Gaussianos latentes, abordagem INLA (aproximações de Lapace integradas aninhadas) e arquitetura espaço-temporal. Resultados: A revisão integrativa apontou que, entre 2010 e 2020, cinco artigos abordaram as temáticas de análise espacial e espaço-temporal na SG e SC. Entre 2010 e 2020 e em todo o estado de São Paulo, as taxas de detecção de SG quadruplicaram e de incidência de SC triplicaram. As taxas brutas e Bayesianas para os dois agravos calculadas para os municípios, mesmo tendo apresentado comportamento heterogêneo, também se mostraram crescentes com o passar do tempo. Na análise com estatísticas de varredura, foram identificados, tanto entre os municípios do Estado, como entre as unidades de análise da capital paulista, aglomerados temporais, espaciais, espaço-temporais de alto risco para SG e SC. As modelagens Bayesianas espaço-temporais confirmaram o crescimento temporal das incidência de SG e SC. No modelo para SG, mostraram-se associadas positivamente à ocorrência desse agravo nos municípios, o índice de Gini, a proporção de pessoas entre 15 e 19 anos que não trabalham ou não estudam. No modelo para SC, além das duas citadas, associaram-se positivamente ao agravo a proporção de mães com pré-natal inadequado, a proporção de mães com menos quatro consultas no pré-natal, e a proporção de nascidos vivos de mães adolescentes. Conclusões: Existem, na literatura mundial, poucos estudos abordando SG e SC do ponto de vista espacial e espaço-temporal. Houve, entre 2010 e 2016, grande aumento na ocorrência de SG e SC nos municípios do estado de São Paulo. Foram identificadas áreas de alto risco para os dois agravos e variáveis associadas positivamente à sua ocorrência, achados podem contribuir para aprimoramento da vigilância e controle da SG e SC.
Introduction: Syphilis has been known since the 15th century to cause a large number of deaths, remaining a serious problem for public health. Worldwide data indicate approximately two million cases of syphilis in pregnant women (SG), and the increased incidence of primary and secondary syphilis in the population, the low quality of prenatal care, has been reflected in the increased incidence of congenital syphilis (SC). The techniques of spatial and spatio-temporal analysis allow identifying high-risk areas and variables associated with the occurrence of the studied phenomena. Objective: This is a descriptive and ecological study of the notified cases of SG and SC in the municipalities of the state of São Paulo, between 2010 and 2016. Analyzes were carried out to detect spatial, spatiotemporal clusters and spatial variation of temporal trends for SG and SC, using scanning statistics. The modeling of the two diseases was performed using latent Bayesian Gaussian models, INLA approach (nested integrated Lapace approximations) and space-time architecture. Method: The integrative review pointed out that, between 2010 and 2020, five articles addressed the themes of spatial and spatio-temporal analysis in SG and SC. Between 2010 and 2020 and across the state of São Paulo, SG detection rates quadrupled and CS incidence rates tripled. The gross and Bayesian rates for the two conditions calculated for the municipalities, even though they showed a heterogeneous behavior, also showed increasing over time. In the analysis with scanning statistics, high-risk temporal, spatial, space-temporal clusters for SG and SC were identified, both among the municipalities of the State and between the units of analysis of the São Paulo capital. The Bayesian spatio-temporal models confirmed the temporal growth of SG and SC incidence. In the SG model, the Gini index was shown to be positively associated with the occurrence of this condition in the municipalities, the proportion of people between 15 and 19 years old who do not work or do not study. In the SC model, in addition to the two mentioned, they were associated the proportion of mothers with inadequate prenatal care, the proportion of mothers with less than four prenatal consultations, and the proportion of live births of adolescent mothers were positively affected. Results: In the analysis of the space-time clusters, there was growth for syphilis in pregnant women and congenital women between 2014 and 2016 (RR = 1.5), meaning a trend in increasing incidence. The risk of pregnant women contracting syphilis was 50% higher within the cluster than outside it. For congenital syphilis, in 29 municipalities the RR was 1.8, showing that the risk of children being born with SC was 80% higher within the cluster and, between 2015 and 2016, eight municipalities had RR of 2.6. In the purely temporal analysis, it was found that there was growth between 2015 and 2016, 90% higher than in other years (RR = 1.90 P = 0.001) and in congenital syphilis, there was similar growth, but in the period from 2014 to 2016. The crude and Bayesian rates for the two conditions varied heterogeneously and showed increasing over time. In modeling, the covariables that were shown to be positively associated with the occurrence of syphilis in pregnant women were the Gini index, the proportion of people between 15 and 19 years old who do not work or do not study, and for congenital syphilis, in addition to the previous two, the proportion of mothers with inadequate prenatal care, proportion of mothers with less than four prenatal consultations, and proportion of live births from LB of adolescent mothers. Conclusions: There are few studies in the world literature addressing SG and SC from the spatial and spatio-temporal point of view. Between 2010 and 2016, there was a large increase in the occurrence of SG and SC in the municipalities of the state of São Paulo. High-risk areas were identified for the two diseases and variables positively associated with their occurrence, findings can contribute to improving the surveillance and control of SG and SC.