Aspectos clínicos e geoepidemiológicos da tuberculose no estado do Maranhão

Abstract

Conducting clinical and geoepidemiological studies on tuberculosis in regions with profound social disparities is crucial. It helps identify aspects that demand special attention from health managers and professionals. From this perspective, we aim to analyze the clinical and geoepidemiological aspects of tuberculosis in the state of Maranhão, Brazil. This ecological study considered all new tuberculosis cases informed to the Sistema de Informação de Agravos de Notificação between January 1st, 2011, and December 2022. In October 2023, we collected data from the Programa Estadual da Tuberculose. We used descriptive statistics to assess the selected clinical and epidemiological variables, and we employed simple and multiple logistic regression models to identify the factors associated with the pulmonary clinical forms of the disease. Herewith, tuberculosis incidence rates were determined each year for the regional health units and the state, with their trends determined by Prais-Winsten regressions. In the same way, we employed area analysis to show the spatial distribution of incidence rates grouped into four-year periods (2011 to 2014, 2015 to 2018, 2019 to 2022). The scan analysis technique was applied to detect clusters in the space-time of new tuberculosis cases. A total of 25,696 new cases were reported, with the majority being male (65.11%), of black/brown race/color (83.88%), living in urban areas (69.39%), and presenting with a pulmonary clinical form (89.52%). Radiography raised suspicions in 76.19% of the cases, and sputum smear microscopy was positive in 50.68%. In 85.95% of cases lacked sputum culture, and 79.87% did not undergo histopathology. HIV serology was negative in 72.90% of the cases, with zero to five contacts registered (81.71%) and examined (79.97%). Alcoholism was present in 82.07%, diabetes mellitus in 85.5%, and mental illness in 93.46% of the cases. Treatment was observed in 65.12% of cases, with a cure rate of 71.12%. Regarding factors associated with pulmonary clinical forms, statistically significant risk factors included age (from 10 to 60 years or more), education (illiterate and incomplete primary education), positive sputum culture, alcoholism, diabetes mellitus, and neglect. Notably, the highest incidence rate was recorded in the São Luís region in 2022, with 73.78 cases/100,000 inhabitants, and the lowest in 2014 in the São João dos Patos region, with 5.82 cases/100,000 inhabitants. The incidence trend increased in the state over the analyzed period. Area analysis revealed a heterogeneous spatial distribution over the 4 years, with the lowest rates detected in regional units such as Açailândia, Presidente Dutra, and São João dos Patos, with the highest rates identified in Santa Inês and São Luis. Furthermore, space time scan statistics revealed three clusters of high relative risk distributed in the regional units of Açailândia and Imperatriz, Caxias, Timon, and Codó, Pinheiros, and São Luis. Such findings highlight the need for health interventions focused on prevention, early detection, and effective treatment of the disease through screening programs and ongoing health education initiatives aimed at mitigating, surveilling, and controlling tuberculosis in the state of Maranhão.