Spatiotemporal patterns and factors associated with mortality from visceral leishmaniasis in a northern state of Brazil.

Abstract

Background: This study analysed the spatiotemporal patterns of visceral leishmaniasis (VL) mortality and the prognostic factors associated with deaths in Tocantins, Brazil.

Methods: We conducted an ecological and retrospective cohort study analysing deaths from VL (2010-2019). The univariate global and local Moran indexes were performed, Kulldorff scan statistics were investigated and multilevel logistic regression analysis was performed.

Results: Among the 2437 confirmed cases, 156 patients died from VL, with mortality rates ranging from 0.4 to 1.9 deaths per 100 000 inhabitants. Spatial autocorrelation of VL mortality rates was observed between municipalities, distributed heterogeneously throughout the period. In the northern region of the state, a cluster with a high spatiotemporal risk of mortality from VL was detected. VL deaths were associated with age (≤1 y [odds ratio {OR} 9.4 {95% confidence interval (CI) 3.9 to 22.0}]; >10-≤20 y [OR 4.5 {95% CI 1.5 to 12.9}]; >20-≤40 y [OR 5.3 {95% CI 2.1 to 13.3}]; >40-≤60 y [OR 13.2 {95% CI 5.4 to 32.4}]; >60 y [OR 30.4 {95% CI 12.2 to 75.5}]), jaundice (OR 1.8 [95% CI 1.2 to 2.7]), haemorrhagic phenomena (OR 2.7 [95% CI 1.5 to 5.0]), splenomegaly (OR 1.7 [95% CI 1.1 to 2.5]) and human immunodeficiency virus co-infection (OR 2.0 [95% CI 1.1 to 3.8]).

Conclusions: Knowing the spatiotemporal behaviour and factors associated with death from VL can contribute to the clinical management of patients and control of the disease.