Diabetes Mellitus na Atenção Primária à Saúde de Imperatriz – MA: Aspectos clínico-epidemiológicos e distribuição espaço-temporal

Abstract

Introduction: Diabetes mellitus (DM) is a significant public health issue, characterized by high prevalence, morbidity, mortality, and socioeconomic impact, especially within the scope of Primary Health Care (PHC). In contexts marked by social inequalities, such as the Brazilian Northeast, clinical-epidemiological analysis combined with spatial approach helps identify priority areas and more vulnerable groups. Objective: To analyze the clinical-epidemiological aspects and spatial distribution of DM cases in PHC in the municipality of Imperatriz, Maranhão, from 2020 to 2024. Methodology: Ecological study with distinct analytical measures, conducted from secondary data collected in January 2025 through the e-SUS/PHC system, provided by the PHC Superintendence of the municipality. Clinical-epidemiological context variables were evaluated using descriptive statistics, with both absolute and relative values expressed. Poisson regression models, prevalence ratios, and their respective 95% confidence intervals were estimated using Rstudio® version 2025.05.0, with a significance level set at 5%. Semiannual prevalence was determined in percentage values over the analyzed period, and its trend was assessed using the Joinpoint Regression Program software, version 5.2.0.0. Cases were georeferenced from complete addresses and geographic coordinates, using the Geocode by Awesome Table® plugin integrated with Google®. Subsequently, they were distributed across the census sectors of the municipality and spatially analyzed by Kernel density in QGIS® version 3.34.8. The study was approved by the Ethics Committee of the Federal University of Maranhão under opinion number 7.239.338. Results: A total of 17,761 cases were recorded, predominantly type 2 DM (88.5%), women (60.0%), individuals aged 60 years or older (54.7%), mixed-race (63.8%), with incomplete elementary education (52.6%) and adequate weight (66.7%). The most frequent comorbidity was systemic arterial hypertension (SAH) (54.7%). Most patients were non-smokers and had no complications such as stroke (CVA) or acute myocardial infarction (AMI). There was a high proportion of missing data, particularly regarding marital status (91.6%). In the multivariate analysis, factors associated with death included age ≥ 60 years, cancer, COPD, and occurrence ofstroke, all with significantly elevated risk. The DM prevalence in Imperatriz ranged from 0.5% in 2020 to 4.3% in 2023, with an average of 2.27%, showing an initial increase followed by a decrease to 1.6% in 2024. The overall trend was stable, with growth between 2020/1–2023/1 (+48.37%) and decline between 2023/1–2024/1 (-30.03%). Approximately 90% of DM cases (15,980) were geocoded, with 92% concentrated in urban census sectors. The application of the Kernel technique revealed heterogeneous and non-random distribution, with areas of high density primarily in the neighborhoods of Centro, Nova Imperatriz, Bacuri, and Juçara. Conclusion: The findings revealed the predominance of DM in the population, with higher rates among the elderly, women, mixed-race individuals, low education, and those comorbid with SAH, predominating over type 2 DM, with an intra-urban concentration of cases. These findings support decision-making, guide resource allocation, and define territorial care priorities, reaffirming the central role of PHC in addressing DM.