Dinâmica espacial da Covid-19 no Estado do Maranhão

Abstract

Covid-19, a disease caused by the SARS-CoV-2 coronavirus, elevated to pandemic level in March 2020, has raised health concerns due to the significant indicators of morbidity and mortality observed. Since it is a recent disease, it is essential to know its epidemiological behavior and regions of prevalence. Spatial analysis methods are efficient for the identification of risk areas, providing subsidies for the optimization of public health policies. The objective of this study was to analyze the spatial distribution of cases and deaths caused by Covid-19 in the state of Maranhão. We carried out an ecological study of the spatial distribution of cases (incidence) and deaths (mortality and lethality), using as unit of analysis the municipalities of Maranhão. The study population included all cases reported in the state of Maranhão between 20.03.2020 and 07.07.2021 and all deaths recorded in the period from 29.03.2020 to 07.07.2021, totaling 323,043 cases and 9,225 deaths. The data were collected from the database of the Maranhão State Department of Health (SES). The population estimates correspond to the year 2020 obtained through the meshes of the Brazilian Institute of Geography and Statistics (IBGE). Incidence, mortality and lethality rates were estimated for the 217 municipalities of Maranhão with the elaboration of thematic maps using the QGis software. The spatial dependence was identified through the Global Moran Index and the delimitation of risk clusters through the Local Moran Index, using the GeoDa software. The results show that the municipalities with the highest incidence per 100,000 inhabitants were: Lagoa do Mato (17,940.5), Feira Nova do Maranhão (17,810.0), Igarapé Grande (14,788.8) and São Raimundo das Mangabeiras (11,375.1) and the lowest incidence in Boa Vista do Gurupi (178.95). In the analysis of mortality per 100,000 inhabitants, the highest rates were in Campestre do Maranhão (304.4), Imperatriz (303.1), João Lisboa (235.9) and Porto Franco (224.1). In relation to lethality, the highest rates were in Boa Vista do Gurupi (26.6%), Paço do Lumiar (21.2%), and Viana (11.9%). The health indicators showed positive spatial autocorrelation, being the Global

Moran indexes of incidence 0.328, mortality 0.348 and lethality 0.161, with p < 0.05. The high- risk clusters for incidence, mortality and lethality were detected located, respectively, in the

Central and Southern mesoregion, the Northern mesoregion and the Western maranhense mesoregion. It is concluded that the cases and deaths of Covid-19 were heterogeneously

distributed in the municipalities, with positive spatial autocorrelation and formation of high- risk clusters for incidence, mortality and lethality, with areas of predominance, influenced by

the intermunicipal flow of people, limited access and availability of health services. The local social and demographic characteristics of the municipalities should be considered in future investigations for a better understanding of the dynamics of the disease, as well as to verify whether the health services are satisfactorily organized and sensitive to the local reality. The findings of this study can contribute to the strengthening of health policies to combat the pandemic, by providing subsidies for the development of strategies aimed at reducing the indicators.