Análise temporal, espacial e fatores relacionados às incidências por sífilis adquirida, gestacional e congênita em Minas Gerais, 2007-2021

Abstract

Syphilis represents a significant challenge for public health in Brazil, with increasing rates in recent years. It is a curable infection categorized into acquired, gestational, or congenital forms. This study aims to analyze the spatial and temporal distribution of incidence and mortality rates of Acquired Syphilis (AS), Gestational Syphilis (GS), and Congenital Syphilis (CS) in Minas Gerais (MG), from 2007 to 2021. It also investigates socioeconomic and healthcare access indicators associated with spatial distribution, focusing especially on congenital syphilis mortality. A population-based ecological study was conducted using data from the Minas Gerais Health Surveillance Portal, considering municipalities and the 10 Planning Regions (PR) of MG. Spatial dependence was analyzed through Global and Local Moran’s Index (LISA), while temporal trends in incidence rates were estimated using Generalized Additive Models (GAM). High-risk spatial clusters were identified using Scan statistics, and municipal risks were estimated using Conditional Autoregressive (CAR) models. Socioeconomic indicators included the Human Development Index (HDI) and Gini Index; healthcare access indicators were coverage of the Family Health Strategy (FHS) and prenatal care coverage, considering a minimum of seven consultations. 83,432 confirmed cases of acquired syphilis were reported, with an average incidence rate, based on the period, of 36.02 per 100,000 inhabitants, for syphilis in pregnant women there were 36,517 cases with an average detection rate of 9.5 per 1,000 live births (LB) and for congenital syphilis there were 21,483 cases with a detection rate average of 5.58 per 1,000 NV. In relation to CS, there were 141 deaths in children under one year of age in the state, with an average mortality coefficient of 3.63 per 100,000 LB.For all forms of syphilis, detection decreased in 2020 but increased again in the subsequent year. Disease occurrence risk was rising and positive for GS and CS from 2014 and for AS from 2015 onwards. Spatial high-risk clusters for GS and CS were identified in the Central, North, Rio Doce, Mata, and Jequitinhonha-Mucuri regions, while AS had a cluster encompassing Central, Mata, Rio Doce, and Midwest regions. Spatial analysis showed an association between having at least seven prenatal consultations and a lower CS mortality coefficient (Moran’s Index = 0.0412, p-value < 0.05). A significant correlation was also observed between higher FHS coverage and lower AS incidence (rho = -0.250, p < 0.0001). The study highlights the importance of Geographic Information Systems (GIS) and spatiotemporal models for health analysis, contributing to the understanding of syphilis epidemiology dynamics in Minas Gerais and providing insights to enhance control and prevention strategies across different PRs. To prevent deaths from CS, it is crucial to expand prenatal consultations, especially in the most vulnerable regions of the state.