Análise espacial das taxas de incidência de hepatites virais no Amazonas, Brasil, período de 2008 a 2018

Abstract

Introduction: Viral hepatitis is a serious public health problem that populations around the world face. Their morbidity and mortality rates impact health systems and generate great economic wear, mainly affecting people in social vulnerability. Objective: to analyze the spatial and temporal distribution of the incidence rates of Hepatitis A, B, C and D in the state of Amazonas, from 2008 to 2018. Method: this is an ecological and cross-sectional study with data from the Information System for Notifiable Diseases granted by the Health Surveillance Foundation of the state of Amazonas. By area unit the state and municipalities and unit time the year. Crude incidence, Bayesian empirical, smoothed incidence, Moran Global and Local index calculations were performed, and Microsoft Excel 2016 software was used for data storage and organization, GeoDa version 1.8.12 for spatial statistics and QGIS 3.0 for elaboration of thematic maps. Results: a total of 6,357 hepatitis A patients were included in the study, the majority of whom were diagnosed in a laboratory manner 5,606 (88.1%), male 3,525 (55.5%), urban area 3,608 (56.8%), age 5-14 years 3,585 (56.4%), institutionalized in schools 1,196 (18.8%), browns 4,565 (71.8%), incomplete primary education 1,740 (27.4%), not vaccinated for HAV 3,452 ( 54.3%) and probable source of infection contaminated water and food 3,081 (48.5%). Regarding Be D hepatitis, 10,620 cases were included in the study, of which 1,301 were hepatitis D, in relation to the profile of the most affected individuals, the majority were diagnosed in the laboratory 9,153 (86.1%), in the chronic form 7,228 (68.1%), male 5,512 (51.9%), rural area 5,836 (55%), age group 20-39 years 5,301 (59.9%), brown 8,052 (75.8%), education incomplete primary education 2,499 (23.5%), incomplete vaccinated / vaccinated for hepatitis B 3,098 (29.2%) and probable source of sexual infection 712 (16.1%). In turn, 3,275 of hepatitis C were reported, the majority of which were diagnosed in a laboratory form 3,251 (99.2%), chronic form 2,800 (85.5%), male 1,683 (51.4%), urban area 2,943 ( 89.9%), age group 40-50 years 1,608 (69.6%), browns 2,696 (82.3%), incomplete elementary school 464 (14.2%) and probable source of sexual infection 181 (5, 5%). The global Moran index was positive and significant (p≤0.05) in all years for all forms of hepatitis. The local Moran identified that, among the municipalities that had an incidence considered to be of concern for hepatitis A, B and D, most belonged to the health regions of Purus, Rio Negro/Solimões, Triângulo Jutaí/Solimões/Juruá and Alto Rio Negro. In turn, hepatitis C affected the regions of Purus, Centro Regional and Rio Negro/Solimões. Conclusion: it is assumed that viral hepatitis mainly affects individuals in social and economic vulnerability, living in border municipalities, located on the banks of the main rivers in the Amazon and close to large urban centers.