Inequalities of visceral leishmaniasis case-fatality in Brazil: A multilevel modeling considering space, time, individual and contextual factors.

<h4>Background</h4>In Brazil, case-fatality from visceral leishmaniasis (VL) is high and characterized by wide differences between the various political-economic units, the federated units (FUs). This study was designed to investigate the association between factors at the both FU and in...

Descripción completa

Guardado en:
Detalles Bibliográficos
Autores principales: Gláucia Cota, Astrid Christine Erber, Eva Schernhammer, Taynãna Cesar Simões
Formato: article
Lenguaje:EN
Publicado: Public Library of Science (PLoS) 2021
Materias:
Acceso en línea:https://doaj.org/article/1c900341a9ec425aa64adff60a2f5cfe
Etiquetas: Agregar Etiqueta
Sin Etiquetas, Sea el primero en etiquetar este registro!
id oai:doaj.org-article:1c900341a9ec425aa64adff60a2f5cfe
record_format dspace
spelling oai:doaj.org-article:1c900341a9ec425aa64adff60a2f5cfe2021-12-02T20:23:48ZInequalities of visceral leishmaniasis case-fatality in Brazil: A multilevel modeling considering space, time, individual and contextual factors.1935-27271935-273510.1371/journal.pntd.0009567https://doaj.org/article/1c900341a9ec425aa64adff60a2f5cfe2021-07-01T00:00:00Zhttps://doi.org/10.1371/journal.pntd.0009567https://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735<h4>Background</h4>In Brazil, case-fatality from visceral leishmaniasis (VL) is high and characterized by wide differences between the various political-economic units, the federated units (FUs). This study was designed to investigate the association between factors at the both FU and individual levels with the risk of dying from VL, after analysing the temporal trend and the spatial dependency for VL case-fatality.<h4>Methodology</h4>The analysis was based on individual and aggregated data of the Reportable Disease Information System-SINAN (Brazilian Ministry of Health). The temporal and spatial distributions of the VL case-fatality between 2007 and 2017 (27 FUs as unit of analysis) were considered together with the individual characteristics and many other variables at the FU level (socioeconomic, demographic, access to health and epidemiological indicators) in a mixed effects models or multilevel modeling, assuming a binomial outcome distribution (death from VL).<h4>Findings</h4>A linear increasing temporal tendency (4%/year) for VL case-fatality was observed between 2007 and 2017. There was no similarity between the case-fatality rates of neighboring FUs (non-significant spatial term), although these rates were heterogeneous in this spatial scale of analysis. In addition to the known individual risk factors age, female gender, disease's severity, bacterial co-infection and disease duration, low level schooling and unavailability of emergency beds and health professionals (the last two only in univariate analysis) were identified as possibly related to VL death risk. Lower VL incidence was also associated to VL case-fatality, suggesting that unfamiliarity with the disease may delay appropriate medical management: VL patients with fatal outcome were notified and had VL treatment started 6 and 3 days later, respectively, in relation to VL cured patients. Access to garbage collection, marker of social and economic development, seems to be protective against the risk of dying from VL. Part of the observed VL case-fatality variability in Brazil could not be explained by the studied variables, suggesting that factors linked to the intra FU environment may be involved.<h4>Conclusions</h4>This study aimed to identify epidemiological conditions and others related to access to the health system possibly linked to VL case-fatality, pointing out new prognostic determinants subject to intervention.Gláucia CotaAstrid Christine ErberEva SchernhammerTaynãna Cesar SimõesPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 15, Iss 7, p e0009567 (2021)
institution DOAJ
collection DOAJ
language EN
topic Arctic medicine. Tropical medicine
RC955-962
Public aspects of medicine
RA1-1270
spellingShingle Arctic medicine. Tropical medicine
RC955-962
Public aspects of medicine
RA1-1270
Gláucia Cota
Astrid Christine Erber
Eva Schernhammer
Taynãna Cesar Simões
Inequalities of visceral leishmaniasis case-fatality in Brazil: A multilevel modeling considering space, time, individual and contextual factors.
description <h4>Background</h4>In Brazil, case-fatality from visceral leishmaniasis (VL) is high and characterized by wide differences between the various political-economic units, the federated units (FUs). This study was designed to investigate the association between factors at the both FU and individual levels with the risk of dying from VL, after analysing the temporal trend and the spatial dependency for VL case-fatality.<h4>Methodology</h4>The analysis was based on individual and aggregated data of the Reportable Disease Information System-SINAN (Brazilian Ministry of Health). The temporal and spatial distributions of the VL case-fatality between 2007 and 2017 (27 FUs as unit of analysis) were considered together with the individual characteristics and many other variables at the FU level (socioeconomic, demographic, access to health and epidemiological indicators) in a mixed effects models or multilevel modeling, assuming a binomial outcome distribution (death from VL).<h4>Findings</h4>A linear increasing temporal tendency (4%/year) for VL case-fatality was observed between 2007 and 2017. There was no similarity between the case-fatality rates of neighboring FUs (non-significant spatial term), although these rates were heterogeneous in this spatial scale of analysis. In addition to the known individual risk factors age, female gender, disease's severity, bacterial co-infection and disease duration, low level schooling and unavailability of emergency beds and health professionals (the last two only in univariate analysis) were identified as possibly related to VL death risk. Lower VL incidence was also associated to VL case-fatality, suggesting that unfamiliarity with the disease may delay appropriate medical management: VL patients with fatal outcome were notified and had VL treatment started 6 and 3 days later, respectively, in relation to VL cured patients. Access to garbage collection, marker of social and economic development, seems to be protective against the risk of dying from VL. Part of the observed VL case-fatality variability in Brazil could not be explained by the studied variables, suggesting that factors linked to the intra FU environment may be involved.<h4>Conclusions</h4>This study aimed to identify epidemiological conditions and others related to access to the health system possibly linked to VL case-fatality, pointing out new prognostic determinants subject to intervention.
format article
author Gláucia Cota
Astrid Christine Erber
Eva Schernhammer
Taynãna Cesar Simões
author_facet Gláucia Cota
Astrid Christine Erber
Eva Schernhammer
Taynãna Cesar Simões
author_sort Gláucia Cota
title Inequalities of visceral leishmaniasis case-fatality in Brazil: A multilevel modeling considering space, time, individual and contextual factors.
title_short Inequalities of visceral leishmaniasis case-fatality in Brazil: A multilevel modeling considering space, time, individual and contextual factors.
title_full Inequalities of visceral leishmaniasis case-fatality in Brazil: A multilevel modeling considering space, time, individual and contextual factors.
title_fullStr Inequalities of visceral leishmaniasis case-fatality in Brazil: A multilevel modeling considering space, time, individual and contextual factors.
title_full_unstemmed Inequalities of visceral leishmaniasis case-fatality in Brazil: A multilevel modeling considering space, time, individual and contextual factors.
title_sort inequalities of visceral leishmaniasis case-fatality in brazil: a multilevel modeling considering space, time, individual and contextual factors.
publisher Public Library of Science (PLoS)
publishDate 2021
url https://doaj.org/article/1c900341a9ec425aa64adff60a2f5cfe
work_keys_str_mv AT glauciacota inequalitiesofvisceralleishmaniasiscasefatalityinbrazilamultilevelmodelingconsideringspacetimeindividualandcontextualfactors
AT astridchristineerber inequalitiesofvisceralleishmaniasiscasefatalityinbrazilamultilevelmodelingconsideringspacetimeindividualandcontextualfactors
AT evaschernhammer inequalitiesofvisceralleishmaniasiscasefatalityinbrazilamultilevelmodelingconsideringspacetimeindividualandcontextualfactors
AT taynanacesarsimoes inequalitiesofvisceralleishmaniasiscasefatalityinbrazilamultilevelmodelingconsideringspacetimeindividualandcontextualfactors
_version_ 1718374094045446144