Spatial analysis of limb amputations in a Northeastern state
DOI:
https://doi.org/10.33448/rsd-v10i12.20520Keywords:
Amputation; Social determinants of health; Diabetes Mellitus; Epidemiology; Spatial analysis; Chronic disease.Abstract
This study aims to analyze the spatial autocorrelation of limb amputations and amputation incidence rates among the municipalities of Alagoas. An ecological study with data from the SUS Department of Informatics, the units of analysis were the municipalities and the amputation rate. Limb amputation cases registered between 2007-2018 were included. The incidence rate was smoothed by the local Bayesian method and the Moran index was used for spatial dependence analysis in TerraView and thematic maps edited in QGis. Spearman correlation and simple regression model compared rates with regional socioeconomic indicators. 9345 amputation records notified in the state. The Bayesian estimate smoothed areas and discriminated heterogeneity with more municipalities with high rates and areas of epidemiological transition. Moran's spatial analysis exhibited quadrennial (2007-2010) global index value 0.133385, (2011-2014) 0.215665, (2015-2018) 0.276478 foreshadowing evidence of positive spatial autocorrelation. The univariate regression analysis showed the amputation incidence rate related to indicators that reflect the population's vulnerable life situation, the unemployment rate (11.4%), per capita income (8.5%) and male illiteracy rate (12.9%) percentages of explanation. The spatial distribution of amputations showed a non-homogeneous distribution pattern with agglomerations in the agreste and eastern regions of Alagoas. They are the ones who feel the impact of inequalities in income distribution, education conditions and difficulty in accessing health services the most. Understanding the geographic growth of CNCDs reveals them as a critical point in public health.
References
Almeida, V. C. D., Araújo, S. T., Negreiros, F. D. S., Aguiar, M. I. F., Moreira, T. R., Crispim, A. P. P. (2017). Micro and macro vascular complications in people with type 2 diabetes mellitus in outpatient care. Rev Rene. 18(6):787-93. http://DOI:10.15253/2175-6783.2017000600012.
Bal, B. S., Khanna, G., Bhardwaj, A., & Singh, K. (2019). Evaluation of risk factors for lower extremity amputation in diabetic foot ulcer: a hospital based observational study in Northern India. Int J Res Med Sci. 7(4), 1190-1195. http://dx.doi.org/10.18203/2320-6012.ijrms20191323.
Callegari-Jacques, S. M. (2009). Bioestatística: princípios e aplicações. Traducao. [s.l.] Artmed Editora.
Canella, D. S., Levy, R. B., Martins, A. P. B., Claro, R. M., Moubarac, J-C, Baraldi, L. G., ..., Monteiro, C. A. (2014). Ultra-processed food products and obesity in Brazilian households (2008-2009). PLoS One, 9(3), p. e92752. https://doi.org/10.1371/journal.pone.0092752.
DATASUS (2010). Departamento de Informática do SUS (DATASUS). http://datasus.saude.gov.br/.
Duncan, Bruce Bartholow, Chor, D., Aquino, E. M. L., Bensenor, I. M., Mill, J. G., Schimidt, M. I., …, Barreto, S. M. (2012). Chronic Non-Communicable Diseases in Brazil: priorities for disease management and research. Revista de Saúde Pública. 46(suppl), pp. 126-134. <https://doi.org/10.1590/S0034-89102012000700017>.
Freire, M. C. M., & Pattussi, M. P. (2018). Tipos de estudos. In: C. Estrela (Org.). Metodologia Científica. Ciência, ensino e pesquisa. (3a. ed., pp. 109-127). Porto Alegre: Artes Médicas.
Graz, H., D'Souza, V. K., Alderson, D., & Graz, M. (2018). Diabetes-related amputations create considerable public health burden in the UK. Diabetes research and clinical practice, 135, pp. 158–165. https://doi.org/10.1016/j.diabres.2017.10.030.
Henry, A. J., Hevelone, N. D., Hawkins, A. T., Watkins, M. T., Belkin, M., & Nguyen, L. L. (2013). Factors predicting resource utilization and survival after major amputation. Journal of vascular surgery, 57(3), 784–790. https://doi.org/10.1016/j.jvs.2012.09.035.
Humphries, M. D., Brunson, A., Li, C. S., Melnikow, J., & Romano, P. S. (2016). Amputation trends for patients with lower extremity ulcers due to diabetes and peripheral artery disease using statewide data. Journal of vascular surgery, 64(6), 1747–1755.e3. https://doi.org/10.1016/j.jvs.2016.06.096.
IBGE (2010). Instituto Brasileiro de Geografia e Estatística (IBGE). Censo Demográfico. https://www.ibge.gov.br/estatisticas/sociais/educacao/9662-censo-demografico-2010.html?t=destaques.
IBGE (2019). Instituto Brasileiro de Geografia e Estatística (IBGE). Em 2019, expectativa de vida era de 76,6 anos. https://agenciadenoticias.ibge.gov.br/agencia-sala-de-imprensa/2013-agencia-de-noticias/releases/29502-em-2019-expectativa-de-vida-era-de-76-6-anos#:~:text=A%20expectativa%20de%20vida%20dos,2018%20(12%2C4).
Jaime, P. C., Santos, L. M. P. (2014). Nutritional transition and the organization of care in food and nutrition in Primary Health Care. Divulgação em Saúde para Debate, (51), p. 72-85.
Jesus-Silva, S. G., Oliveira, J. P., Brianezi, M. H. C., Silva, M. A. M., Krupa, A. E., & Cardoso, R. S. (2017). Analysis of risk factors related to minor and major lower limb amputations at a tertiary hospital. J Vasc Bras. 16(1), 16-22. https://doi.org/10.1590/1677-5449.008916.
Lin, C., Armstrong, D. G., Lin, C., Liu, P., Hung, S., Lee, S., …, Huang, Y. (2019). Nationwide trends in the epidemiology of diabetic foot complications and lower-extremity amputation over an 8-year period. BMJ Open Diabetes Research and Care. 7, e000795. https://doi: 10.1136 / bmjdrc-2019-000795.
Louzada, M. L. C., Martins, A. P. B., Canella, D. S., Baraldi, L. G., Levy, R. B. Claro, R.M., ..., Monteiro, C. A. (2015). Ultra-processed foods and the nutritional dietary profile in Brazil. Revista de Saúde Pública, 49(38), 1-11. https://doi.org/10.1590/S0034-8910.2015049006132.
Lucas, E. T. O. D. (2016). Distribuição espaço-temporal da prevalência de pé diabético e amputações por diabetes no Brasil antes e após a Lei nº11.347/06. Dissertação (mestrado) – Universidade Federal do Rio Grande do Norte. Centro de Ciências da Saúde. Programa de Pós-Graduação em Saúde Coletiva, Natal.
Ministério da Saúde (2016). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Manual do pé diabético: estratégias para o cuidado da pessoa com doença crônica /Ministério da Saúde. http://189.28.128.100/dab/docs/portaldab/publicacoes/manual_do_pe_diabetico.pdf.
Ministério da Saúde (2021). Secretaria de Atenção Primária à Saúde (SAPS). PAINÉIS DE INDICADORES - Atenção Primária à Saúde. https://sisaps.saude.gov.br/painelsaps/saude-familia.
Peek, M. E. (2011). Gender Differences in Diabetes-related Lower Extremity Amputations. Clinical Orthopaedics and Related Research, 469(7), 1951–1955. https://doi.org/10.1007/s11999-010-1735-4.
Peixoto, A. M., Zimpel, S. A., Oliveira, A. C. A., Monteiro, R. L. S., & Carneiro, T. K. G. (2017). Prevalence of upper and lower limb amputations of SUS patients in the state of Alagoas between 2008 and 2015. Fisioter Pesqui. 24(4), 378-384. https://doi:10.1590/1809-2950/17029524042017.
Plano Diretor de Regionalização da Saúde de Alagoas (2009). PLANO DIRETOR DE REGIONALIZAÇÃO DA SAÚDE DO ESTADO DE ALAGOAS - PDR/AL. http://cidadao.saude.al.gov.br/transparencia/observatorios/observatorio-das-despesas-publicas-da-saude/monitoramento-da-saude/plano-diretor-de-regionalizacao-pdr/.
Plano Diretor de Regionalização da Saúde de Alagoas (2011). PLANO DIRETOR DE REGIONALIZAÇÃO DA SAÚDE DO ESTADO DE ALAGOAS - PDR/AL - Revisão no Ano 2011. https://www.saude.al.gov.br/wp-content/uploads/2020/06/pdr_2011.pdf.
PNUD (2010). Programa das Nações Unidas para o Desenvolvimento (PNUD). Índice de Desenvolvimento Humano. https://www.br.undp.org/content/brazil/pt/home/idh0/conceitos/o-que-e-o-idhm.html.
Rodrigues, F. F. L. (2015). Tendência de internações hospitalares de pacientes com e sem o diagnóstico de diabetes mellitus submetidos à amputação não traumática de extremidades inferiores, Ribeirão Preto - SP, 2001-2008. Tese de Doutorado, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto. doi:10.11606/T.22.2015.tde-29052015-192858. Recuperado de www.teses.usp.br.
Rolim, D., Sampaio, S., Gonçalves‐Dias, P., Almeida, P., Almeida‐Lopes, J., & Teixeira, J. F. (2015). Mortalidade depois da Amputação. Angiol Cir Vasc. 11(3), 166-170. https://doi.org/10.1016/j.ancv.2015.06.001
Santos, K. P. B., Luz, S. C. T., Mochizuki, L., & d'Orsi, E. (2018). Burden of disease from lower limb amputations attributable to diabetes mellitus in Santa Catarina State, Brazil, 2008-2013. Cad. Saúde Pública. 34(1), e00013116. https://doi.org/10.1590/0102-311X00013116.
Senefonte, F. R. A., Rosa, G. R. P. S., Comparin, M. L., Covre, M. R., Jafar, M. B., Andrade, F. A. M., ..., Nogueira Neto, E. (2012). Primary amputation in trauma: a profile of hospital Center-west region of Brazil. J Vasc Bras, 11(4). https://doi.org/10.1590/S1677-54492012000400004.
Sociedade Brasileira de Diabetes (2019). Sociedade Brasileira de Diabetes (SBD). Diretrizes da Sociedade Brasileira de Diabetes 2019-2020. Rio de Janeiro: Clannad Editora Científica. http://www.saude.ba.gov.br/wp-content/uploads/2020/02/Diretrizes-Sociedade-Brasileira-de-Diabetes-2019-2020.pdf.
Toscano, C. M., Sugita, T. H., Rosa, M., Pedrosa, H. C., Rosa, R., & Bahia, L. R. (2018). Annual Direct Medical Costs of Diabetic Foot Disease in Brazil: A Cost of Illness Study. International journal of environmental research and public health, 15(1), 89. https://doi.org/10.3390/ijerph15010089.
World Health Organization (2014). Global status report on noncommunicable diseases 2014. WHO Document Production: Geneva, Switzerland.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Regina Nunes da Silva; Rosário de Fátima Alves de Albuquerque; Paulyanne Karlla Araújo Magalhães; Ewerton Amorim dos Santos; Ruth França Cizino da Trindade; Juliane Maria Alves Siqueira Malta; Marco Antônio Prado Nunes; Francilene Amaral da Silva
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.