Autocorrelação espacial dos casos de tuberculose pulmonar durante a pandemia COVID-19: impactos causados no estado da Paraíba

Abstract

Introduction: Despite presenting itself as an ancient disease, tuberculosis (TB) still remains a serious global public health problem. Its characteristics related to the maintenance of social inequality were even more intensified after the emergence of COVID-19, as the pandemic ended up limiting access to health services, causing interruptions in the management and treatment of the disease, contributing for changes in TB incidence rates, which went from 37.4 in 2019 to 31.6 cases per 100 thousand inhabitants in 2020 in Brazil. Objective: To analyze spatial autocorrelation and the impacts caused COVID-19 pandemic on tuberculosis cases in the state of Paraíba. Methods: Cross-sectional and analytical ecological study, carried out in the state of Paraíba using spatial analysis techniques, descriptive statistics and logistic regression with notifications carried out between January 2020 and November 2022. Data were extracted from the State Control Program of Tuberculosis (PECT) and the Center for Chronic and Neglected Diseases (NDCN). The descriptive analysis was carried out through the evaluation of the variables sex, race/color, education, cause of entry, clinical form and residence zone. For the analysis of spatial autocorrelation, the Global and Local Moran Index was used. The logistic regression calculation occurred after checking the Wald tests, Akaike criterion, Variance Inflation Factor (VIF) and Receiver operating characteristic curve (ROC curve), using the variables: diseases and conditions associated with AIDS, sex, diabetes , mental illnesses, use of illicit drugs, homeless people and beneficiaries of the government's income transfer program, with the response variable being the patient's cure. A significance level of 5% and a confidence interval of 95% were considered, using the software R (version 4.3.1) and Rstudio (Rcore team, 2023). Results: During the period analyzed in the study, 4,895 cases of TB were reported in the state of Paraíba, with a predominance of males (70.32%), brown skin color (74%), pulmonary TB (83.90%) and residence in the urban area (88.68%). The spatial analysis showed high incidence rates of the disease in municipalities located on the coast of the state and in Sertão Paraibano (2020); in the south of the coast, Agreste Paraibano and Sertão Paraibano (2021); and in concentrations from Mata Paraibana to Agreste Paraibano (2022). The Moran (I) showed positive spatial autocorrelation (2021: I = 0.1613 and p = 0.0000; 2022: I = 0.0831 and p = 0.0095). Logistic regression showed a greater chance of cure among patients without AIDS (ACR=4.78; 95%CI 1.84-12.42) and with a fixed residence (ACR=8.65; 95%CI 1.51-49.44) in 2020 and patients without AIDS (ACR=4.62; 95%CI 2.01-10.64) in 2021. Conclusion: The georeferencing of TB cases presented itself as an indispensable tool for public health, helping to implement actions and strategies for TB control and monitoring. Considering that the social isolation measures caused by COVID-19 ended up limiting access to these health services.