Análise espaço-temporal da mortalidade e dos casos de insuficiência renal no estado de São Paulo

Abstract

Renal failure (RF) is a progressive and serious disease, representing a significant challenge to public health. The disease is characterized by the loss of functional capacity of the kidneys, which can lead to complications and premature death. Although the Ministry of Health makes data on RI cases and mortality available at the municipal level, the spatial distribution pattern of this disease in the State of São Paulo is unknown. This is essential to support the definition of effective public health policies, according to the areas most affected by the disease. Therefore, the objective of the present study was to analyze the spatio-temporal distribution of mortality and the rate of renal failure (acute, chronic and unspecified) in the State of São Paulo from 2008 to 2021, correlating them with sociodemographic factors. To this end, the following were carried out: (i) collection of mortality data due to RF (Cause list - ICD-BR-10) by municipality in the state of São Paulo, through the Mortality Information System (MIS); (ii) survey of the number of Hospital Admission Authorizations (HAA) approved for renal failure (ICD-10 Morbidity list), by municipality in the state of São Paulo and sociodemographic data (e.g., age, gender) in the DATASUS database; (iii) organization of the cartographic base of municipal boundaries; (iv) data processing, including calculation of the mortality rate and renal failure rate, exploratory data analysis, calculation of temporal trends in the distribution of the mortality rate and renal failure rate in the state, and use of detection and analysis methods spatial grouping; and (v) preparation of uni- and bivariate thematic maps to explore and analyze the observed patterns. The period of data analysis was from 2008 to 2021. The data available in DATASUS for mortality (Cause list - ICD-BR-10) and approved HAA (ICD-10 Morbidity list) for RF jointly consider acute renal failure (N17), chronic renal failure (N18) and unspecified renal failure (N19). Data processing, analysis and representation were carried out in a Geographic Information System (GIS). The distribution pattern of RF rate and mortality in the State is not random. There is an upward trend in the IR rate and the number of deaths. Men are the most affected by the disease and have the highest number of deaths, with the age group over 59 being the most vulnerable. The most critical regions for IR are those located to the west of the State, especially the mesoregion of São José do Rio Preto. The results of this work represent important sources of data for Medicine, allowing the identification of areas and periods of higher incidence of IR. they can help guide future preventive and social measures and kidney failure management actions, including awareness campaigns, early screening and therapeutic interventions, aiming to reduce the incidence and mortality from IR. It also allows the implementation of prevention and control programs adapted to the specific needs of each region and population group, including education on healthy lifestyle habits, adequate management of chronic diseases and access to health services, especially in regions that have demonstrated higher prevalence and deaths by the disease. Furthermore, the data obtained can contribute to the planning and allocation of health resources, according to local particularities, aiming to mitigate the impacts of this disease. This research contributes to an epidemiological analysis that can inform the competent sectors to create care models adapted to local needs. This study also strengthens the ability of health professionals to face renal failure in their daily clinical practice, offering more personalized and effective care to patients, according to local and sociodemographic particularities, promoting better clinical results and quality of life.