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.

The use of geographical analysis in assessing the impact of patients' home addresses on their participation in outpatient cardiac rehabilitation: a prospective cohort study

PURPOSE@#Geographical analysis is becoming a powerful tool for evaluating the quality of medical services and acquiring fundamental data for medical decision-making. Using geographical analysis, we evaluated the impact of the distance from patients' homes to the hospital on their participation in outpatient cardiac rehabilitation (OCR).@*METHODS@#All patients hospitalized for percutaneous coronary intervention, coronary artery bypass grafting, valvular surgery, congestive heart failure, and aortic diseases were advised to participate in an OCR program after discharge. Using the dataset of our cohort study of OCR from 2004 to 2015 (n = 9,019), we used geographical analysis to investigate the impact of the distance from patients' homes to hospital on their participation in our OCR program.@*RESULTS@#Patients whose road distance from home to hospital was 0-10 km, 10-20 km, and 20-30 km participated more in OCR than those whose road distance was ≧ 30 km (OR 4.34, 95% CI 3.80-4.96; OR 2.98, 95% CI 2.61-3.40; and OR 1.90, 95% CI 1.61-2.23, respectively). Especially in patients with heart failure, the longer the distance, the lesser the participation rate (P < .001).@*CONCLUSIONS@#Using geographical analysis, we successfully evaluated the factors influencing patients' participation in OCR. This illustrates the importance of using geographical analysis in future epidemiological and clinical studies.@*TRIAL REGISTRATION@#UMIN000028435.

Schistosomiasis in the middle paranapanema river region, state of São Paulo, Brazil: does it matter today for public health?

Abstract INTRODUCTION: The Middle Paranapanema watershed is known for the transmission of schistosomiasis, and there have been autochthonous cases since 1952. This study aimed to describe this disease in space and time and evaluate its current importance as a public health problem. METHODS: Thematic maps showing the risk areas for transmission of schistosomiasis, using scan statistics, and flow maps were created in the period 1978-2016. Incidence was calculated, and the existence of spatial dependence between autochthonous and imported cases was evaluated using Ripley's K12-function. Species of snails were identified in high-risk clusters. RESULTS: A total of 1,511 autochthonous cases were reported in eight of the 25 municipalities in the study area, of which 92.8% occurred in Ourinhos. A total of 2,189 imported cases were reported (27% in Ourinhos and 20% in Assis), mainly originating in the states of Paraná and Minas Gerais. Clusters of autochthonous and imported cases with higher risk were identified in Ourinhos, Assis and Ipaussu. However, over the years, the cases began to occur in low density in Ourinhos and no longer in other municipalities in the region. The cluster detected in the period 2007-2016 in Ourinhos still has risk for the transmission of schistosomiasis. K12-function analysis indicated positive spatial dependence between autochthonous and imported cases. CONCLUSIONS: The study showed that, currently, schistosomiasis as a public health problem in Middle Paranapanema is restricted to Ourinhos. This fact may be related to the presence of Biomphalaria glabrata at a specific point and low coverage of basic sanitation.