Análise espaço-temporal de internações por diarreias de causa presumivelmente infecciosas, tifos e paratifos em crianças e idosos em regiões do estado de São Paulo: uso de técnicas estatísticas complementares para vigilância epidemiológica

Abstract

Introduction: In Brazil and other countries, an important indicator for assessing health conditions is the incidence of acute diarrhea. Objective: Use the Shewhart control charts, cumulative sum (CUMSUM) and exponentially weighted moving average (EWMA) to assess monthly rates of hospitalizations for childhood diarrhea in the macro regions of Araçatuba, Marília and Presidente Prudente, SP, from June 2009 and analyze the time-space distribution of monthly hospitalizations for presumably infectious diarrhea in individuals aged 60 or over, between June 2009 and July 2019. Methods: The average rates and their standard deviations for admission of diarrhea in the target population were obtained from DATASUS and standardized for cases x 100,000 inhabitants. Confidence limits were established, occurrences above confidence limits were considered epidemic events. Data normality and serial autocorrelation were tested using the Shapiro-Wilk and Durbin-Watson method. The time series were conducted using the Prais-Winsten regression method. From the estimated regression coefficients, the monthly rates of hospitalizations for diarrhea were calculated. The results were used to build a thematic map, identifying the mesoregions of the State of São Paulo. The rates of growth and decrease were subjected to Pearson's correlation analysis with SIDRA parameters (IBGE's Automatic Recovery System) about the sanitation conditions of each municipality. Results: All methods detected epidemic occurrences in the three regions. Araçatuba and Marília, the peaks were concentrated in the first half of the decade and Presidente Prudente, close to the middle. The CUMSUM method was more sensitive to detect epidemic periods, but the data and assumptions of normality were violated by serial autocorrelation in a few months. The EWMA method was considered the most appropriate. It was found that there are more municipalities with an increase in cases of hospitalizations caused by diarrhea than reductions. There was no association between basic sanitation and hospitalizations for diarrhea. Conclusions: Statistical process control charts can be used to monitor and compare disease incidence between different regions. In the last 10 years, the number of cases of hospitalizations for diarrhea has increased more than it has decreased in the state of São Paulo.