Traumas orais e maxilofaciais como marcadores de violência urbana: Padrão de distribuição espacial e perfil de risco

Abstract

The aim of this study was to investigate the spatial and spatial-temporal distribution of oral and maxillofacial traumas caused by urban violence, as well as to identify underlying disparities at the regional level through a geostatistical approach. This was a historical ecological cohort study of trauma cases caused by urban violence using aggregated data from victims assisted in a Brazilian medical-forensic service between January 2012 and December 2015. The longitudinal patterns of change observed in each geographical area (neighborhoods) were evaluated using finite mixture models. The spatial autocorrelation of events was investigated using the Getis-Ord Indicator (Gi*) to identify significant hot and cold spatial clusters. With a spatial regression model, it was also investigated when socioeconomic variables, residential infrastructure and neighborhood infrastructure were associated with high incidence rates. The level of significance was set at p ≤ 0.05. The results showed that the events were not randomly distributed in the geographic space, being concentrated in certain neighborhoods. Different patterns of longitudinal trajectory of incidence cases were observed (p <0.05). The Gi* statistic identified significant high-risk clusters in the West (p <0.05) and in the South (p <0.05) and low risk in the North (p <0.05). The spatial regression model indicated a significant association between areas with unfavorable socioeconomic conditions and a higher incidence of events (p <0.05). Areas with high socio-spatial vulnerability for urban violence and oral and maxillofacial traumas were identified. The findings highlight the need to improve living conditions in segregated urban areas and develop intersectoral actions aimed at improving living conditions, employment, public safety, social support, health care and prevention.