COMORBIDADE TUBERCULOSE-DIABETES MELLITUS: aspectos clínico- epidemiológicos e análise espacial em Imperatriz – MA

Abstract

The objective was to analyze the clinical and epidemiological aspects of the comorbidity Tuberculosis (TB) - Diabetes Mellitus (DM) and its spatial distribution in Imperatriz – MA. This is an ecological study with multiple measures of analysis, carried out using data from the Notifiable Diseases Information System, related to TB cases associated with the DM condition, recorded in the period between 2008 and 2019, which were collected in November 2019, with the Health Surveillance Service of the Regional Health Management Unit of Imperatriz. The prevalence was determined in percentage values of TB-DM comorbidity each year, the average and its trend for the period, calculated using the Prais-Winsten regression. To identify the factors associated with comorbidity, Poisson regression models, prevalence ratios (PR) and the respective 95% confidence intervals were used, which were estimated using the SPSS 24.0 software, setting a level of significance at 5%. The cases were geocoded using the TerraView software and the Batch Geocode tool. Kernel analysis and spatial scanning were performed, and the maps were generated using ArcGis 10.5 software. 721 cases of tuberculosis were reported, of which 81 were associated with DM. The prevalence ranged from 3.2% in 2014 to 19.5% in 2018, with an average of 11.5% for the period, showing an increasing trend. The age groups from 30 to 59 years and ≥ 60 years, education <8 years and clinical form of pulmonary tuberculosis were risk factors for comorbidity. Regarding spatial analysis, it was found that the distribution of cases of comorbidity was heterogeneous, ranging from 0.00 to 4.12 cases / km2. The spatial scan analysis detected three spatial clusters of statistically significant high risk (p <0.005), which were: spatial cluster 1 (RR = 4.00; 95% CI = 2.60 - 6.80; p <0.001) that encompassed 4 census sectors involving the Vila Lobão neighborhood; spatial cluster 2 (RR = 5.10; 95% CI = 2.75 - 7.30; p <0.001) which also involved four census sectors, referring to the Vilinha and Parque Alvorada neighborhoods; spatial cluster 3 that presented the highest risk (RR = 6.10; 95% CI = 3.21 - 8.92; p <0.002) and encompassed three census sectors belonging to the Bacuri and Parque do Buriti neighborhoods. The growing trend of the prevalence of TB-DM comorbidity and its associated factors, warns about the need to improve care in the levels of health care. The higher density of cases of comorbidity, as well as clusters, were present in areas of greater circulation of people and vulnerable from a socioeconomic and environmental point of view. Such findings may contribute to the implementation of health actions, aimed at high-risk areas and the integrated management of health problems, in addition to subsidizing public health interventions, aimed at reducing health disparities and social inequalities in the investigated territory.