Epidemiological patterns related to deaths caused by visceral leishmaniasis in the southern Amazon region of Brazil.

Autor:	Carvalho AG; School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis, 5055 dos Estudantes Ave. Rondonópolis, Mato Grosso, 78736-900, Brazil., Kuhn ALM; School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis, 5055 dos Estudantes Ave. Rondonópolis, Mato Grosso, 78736-900, Brazil., Dias JVL; School of Medicine, Federal University of Jequitinhonha and Mucuri Valleys, 1 Cruzeiro St. Teófilo Otoni, Minas Gerais, 39803-371, Brazil., Luz JGG; School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis, 5055 dos Estudantes Ave. Rondonópolis, Mato Grosso, 78736-900, Brazil.
Jazyk:	angličtina
Zdroj:	Transactions of the Royal Society of Tropical Medicine and Hygiene [Trans R Soc Trop Med Hyg] 2023 May 02; Vol. 117 (5), pp. 326-335.
DOI:	10.1093/trstmh/trac110
Abstrakt:	Background: We analysed the spatial and spatiotemporal patterns of visceral leishmaniasis (VL) mortality at the municipality level in an endemic state in the southern Amazon region of Brazil. Individual-level factors associated with death due to VL were also investigated. Methods: All VL cases and deaths reported between 2007 and 2018 were included. The global and local bivariate Moran's index assessed the space-time autocorrelation of smoothed triennial VL mortality. Kulldorff's scan statistics investigated spatial and spatiotemporal clusters. A multivariable logistic regression explored sociodemographic, diagnostic and clinical variables associated with death due to VL. Results: We observed an overall VL mortality and lethality of 0.14 cases/100 000 inhabitants and 11.2%, respectively. A total of 14% of the municipalities registered at least one VL-related death. In the southeastern mesoregion of the state, we detected high-risk spatial (relative risk [RR] 14.14; p<0.001) and spatiotemporal (RR 15.91; p<0.001) clusters for VL mortality. Bivariate Moran's analysis suggested a high space-time autocorrelation of VL mortality. Death by VL was associated with age ≥48 y (odds ratio [OR] 7.2 [95% confidence interval {CI} 3.4 to 15.3]), displacement for notification (OR 3.3 [95% CI 1.5 to 7.2]) and occurrence of oedema (OR 2.8 [95% CI 1.3 to 6.1]) and bleeding (OR 5.8 [95% CI 2.6 to 12.8]). Conclusions: VL mortality has a heterogeneous spatiotemporal distribution. The death-related factors suggest late diagnosis as an underlying cause of mortality. (© The Author(s) 2022. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)
Databáze:	MEDLINE
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