Variabilidad geográfica, inequidades en salud y letalidad por COVID-19 en Bariloche, Río Negro, 2020-2021 / Geographic variability, health inequities and lethality due to COVID-19 in Bariloche, Río Negro, 2020-2021

Resumen Introducción : El objetivo de este estudio fue exami nar cómo la variabilidad geográfica y los determinantes sociales de la salud influyen en la tasa de letalidad por COVID-19 en Bariloche. Métodos : Se utilizó una base de datos del Sistema Nacional de Vigilancia Epidemiológica para analizar los casos positivos de COVID-19 desde enero de 2020 hasta diciembre de 2021. Los datos se geo-codificaron y se incorporaron en un sistema de información geográfica (SIG). Se aplicó un marco de análisis en tres pasos para medir la inequidad en salud, utilizando indicadores socioeconómicos y de acceso a servicios. Se realizó un análisis multivariado para predecir la letalidad. Resultados : Se diagnosticaron un total de 25 020 casos de COVID-19 en Bariloche durante el período de estudio. La letalidad fue del 2.1%. Se observó una variabilidad significativa en indicadores socioeconó micos entre las diferentes delegaciones territoriales de la ciudad. Discusión : Los resultados mostraron inequida des en salud y una asociación entre determinantes sociales y letalidad por COVID-19 en Bariloche. Las personas que vivían en áreas con mayor vulnerabili dad socioeconómica presentaron un mayor riesgo de mortalidad. Estos hallazgos resaltan la importancia de abordar las inequidades en salud en la respuesta a una pandemia.

Abstract Introduction : The objective of this study was to ana lyze the geographic variability and the relationship between social determinants of health and COVID-19 lethality in Bariloche. Methods : A database from the National Epidemiologi cal Surveillance System was used to analyze COVID-19 positive cases from January 2020 to December 2021. The data were geocoded and incorporated into a geo graphic information system (GIS). A three-step analytical framework was applied to measure health inequity, us ing socioeconomic indicators and access to services. A multivariate analysis was conducted to predict fatality. Results : A total of 25 020 COVID-19 cases were diag nosed in Bariloche during the study period. The fatality rate was 2.1%. Significant variability in socioeconomic indicators was observed among different territorial delegations of the city. Discussion : The results showed health inequities and an association between social determinants and COVID-19 lethality in Bariloche. Individuals living in areas with higher socioeconomic vulnerability had a higher risk of mortality. These findings highlight the importance of addressing health inequities in a pan demic response.

Geographic and demographic variabilities of quantitative parameters in stress myocardial computed tomography perfusion

BACKGROUND/AIMS: To evaluate the geographic and demographic variabilities of the quantitative parameters of computed tomography perfusion (CTP) of the left ventricular (LV) myocardium in patients with normal coronary artery on computed tomography angiography (CTA). METHODS: From a multicenter CTP registry of stress and static computed tomography, we retrospectively recruited 113 patients (mean age, 60 years; 57 men) without perfusion defect on visual assessment and minimal (< 20% of diameter stenosis) or no coronary artery disease on CTA. Using semiautomatic analysis software, quantitative parameters of the LV myocardium, including the myocardial attenuation in stress and rest phases, transmural perfusion ratio (TPR), and myocardial perfusion reserve index (MPRI), were evaluated in 16 myocardial segments. RESULTS: In the lateral wall of the LV myocardium, all quantitative parameters except for MPRI were significantly higher compared with those in the other walls. The MPRI showed consistent values in all myocardial walls (anterior to lateral wall: range, 25% to 27%; p = 0.401). At the basal level of the myocardium, all quantitative parameters were significantly lower than those at the mid- and apical levels. Compared with men, women had significantly higher values of myocardial attenuation and TPR. Age, body mass index, and Framingham risk score were significantly associated with the difference in myocardial attenuation. CONCLUSIONS: Geographic and demographic variabilities of quantitative parameters in stress myocardial CTP exist in healthy subjects without significant coronary artery disease. This information may be helpful when assessing myocardial perfusion defects in CTP.

Variabilidad geográfica en la detección temprana del cáncer cervicouterino entre servicios integrados de atención en Costa Rica, 2004 - 2005 / Geographical variability in the early detection of cervical cancer among integrated health care services in Costa Rica

Objetivo: Realizar un análisis comparativo de los resultados de la detección temprana del cáncer cervicouterino, mediante la identificación de patrones geográficos en los tres servicios integrados del sistema público de salud costarricense. Material y métodos: Se realizó un análisis de variabilidad para el período 2004-2005 del porcentaje de cobertura de Papanicolaou ajustada por edad, utilizando como indicadores la razón de variación, RV p95-5, el coeficiente de variación, CVp95-5, y el gráfico de puntos. En la representación geográfica se usó el índice de cobertura estandarizada, que compara la cobertura de cada área de salud con el promedio nacional, utilizando el mapa de Costa Rica para representar los tres servicios integrados de salud. Resultados: El área de salud ubicada en el percentil 95 registró una cobertura 2,3 veces mayor que la ubicada en el percentil 5. Entre servicios integrados, se observó moderada variabilidad en los servicios 1 y 2, CV igual 19 por ciento y 21 por ciento respectivamente, y baja en el servicio 3, CV igual 12.9 por ciento. Se determinó un patrón geográfico de baja cobertura de Papanicolaou en las áreas de salud de la zona costera del caribe, frontera norte con Nicaragua y centro del país, las cuales están ubicadas en los servicios integrados y 3. Conclusiones: Las estrategias actuales de cobertura de la toma del Papanicolaou no parecen estar enfocadas a priorizar las áreas de salud más pobres y con mayores tasas de mortalidad evitable por esta patología, ya que éstas son una de las principales características de las zonas identificadas como de baja cobertura respecto al nivel nacional.

Objective: To carry out a comparative analysis of the early screening results of cervico-uterine cancer, by means of the identification of geographic patterns in the three comprehensive health services of the Costa Rican Social Security system. Materials and methods: A variability analysisfor carried out for the period 2004-2005 for the ageadjustedpercent coverage by Pap smear using asindicators the variation ratio (RV p95-5), the coefficient of variation (CV p95-5) and a dot graphic. For thegeographic representation, was used an adjusted index which compares the coverage in each health area withthe national average, using the map of Costa Rica to represent the three integrated health services. Results: The health area located in the 95th. percentile showed coverage that was 2.3 times greater than that located in the 5th. percentile. Among integratedservices, a moderate degree of variability in services 1 and 2 (CV= 19% and 21%, respectively) and alow degree of variability in service 3 (CV=12.9%) were observed. A geographic pattern of low Pap smearcoverage was seen in the health areas of the Caribbean coastal area, the northern border with Nicaragua aswell as the middle part of the country, both of which are located in integrated health services 1 and 3. Conclusions: The present coverage strategiesfor taking a Pap smear appear not to emphasize the priorization of the poorest health areas which also havethe greatest preventable mortality due to cervicouterine cancer since we observed that this was one of the maincharacteristics of the areas identified as having low national coverage.