Spatiotemporal Distribution of Cutaneous Leishmaniasis in Relation to Climate Factors, Pará, Brazil, 2007-2019 Restricted; Files Only
Leiser, Margalit (Spring 2024)
Published
Abstract
Background Cutaneous leishmaniasis (CL) is an endemic vector-borne disease of Brazil, which is home to ~40% of CL cases in the Americas. Well-known environmental factors associated with incidence include deforestation, precipitation, and temperature, but CL dynamics are highly variable and little data are available for many states. This study evaluates the role of environmental factors on CL incidence in the state of Pará (PA), identifying high-risk and likely regional clusters of disease incidence.
Methods A spatiotemporal ecological study utilizing publicly sourced confirmed cases of CL by reporting municipality was conducted from 2007 through 2019. Cumulative and annual incidence rates were mapped to evaluate spatial heterogeneity. Multivariate negative binomial regression models were generated for the overall period and annually to investigate the associations between factors including minimum temperature, maximum temperature, total precipitation, urbanicity of residence, and Multivariate El Nino Southern Oscillation Index (MEI). Local indicator of spatial autocorrelation (LISA) and Kulldorff spatial scan statistics were conducted to evaluate clustering.
Results Over the study period, 46,163 cases of CL were reported from PA (population 7,588,078). Cumulative incidence was 608 cases per 100,000 people, with average annual incidence of 47 cases per 100,000 people. In the overall model, which explained 57% of variance, monthly minimum temperature, monthly maximum temperature, and monthly total precipitation were significantly, inversely associated with CL incidence in Pará. Urbanicity and month displayed significant, direct association with CL incidence. Seasonally lagged MEI and year did not achieve significance in the overall model. There was a spatially heterogenous distribution of high-high and low-low risk municipalities across the state, and stable and significant clusters of highest-risk municipalities were found in the northwestern and southwestern regions of the state.
Discussion This study provides insight into the distribution of CL across Pará, showing a likely role of environmental factors including minimum and maximum monthly temperature and total monthly precipitation on disease incidence and clustering in the state. These results suggest possible factors of influence leading to high incidence years and tactics for managing prevention and control efforts of CL in Pará, Brazil.
Table of Contents
Table of Contents
LITERATURE REVIEW ...............................................................................................................1
MANUSCRIPT ...............................................................................................................................9
ABSTRACT ....................................................................................................................................9
INTRODUCTION ........................................................................................................................11 METHODS....................................................................................................................................13
RESULTS......................................................................................................................................17
DISCUSSION .............................................................................................................................. 22
CONCLUSIONS ......................................................................................................................... 28
SUMMARY ................................................................................................................................. 28
PUBLIC HEALTH IMPLICATIONS.......................................................................................... 28
FUTURE DIRECTIONS ............................................................................................................. 29
REFERENCES ............................................................................................................................ 31
TABLES ..................................................................................................................................... 34
Table 1. Descriptive Characteristics of Patients Diagnosed with Cutaneous Leishmaniasis in Pará, Brazil, 2007-2019............................................................................................................... 34 Table 2. Overall Multivariate Analysis of Climatologic and Sociologic Factors with Cutaneous Leishmaniasis Incidence in Pará, Brazil, 2007-2019.................................................................... 35
FIGURES ..................................................................................................................................... 36
Figure 1. Map of Pará, Brazil. .......................................................................................................36
Figure 2. Distribution and Cumulative Incidence of Cutaneous Leishmaniasis Cases by Resident Municipality, Pará, 2007-2019......................................................................................................37
Figure 3. Municipalities Considered Significant High Risk Areas for Cutaneous Leishmaniasis, Pará, Brazil.................................................................................................................................... 38
Figure 4. Local Spatial Autocorrelation of Cutaneous Leishmaniasis Incidence in Pará, Brazil, and Clustering Analysis for Cutaneous Leishmaniasis Clustering in Pará, Brazil, 2007-2019................................................................................................................................................39
Figure 5. Local Spatial Autocorrelation of Cutaneous Leishmaniasis Incidence in Pará, Brazil in High- and Low-Incidence Years................................................................................................... 40
SUPPLEMENT............................................................................................................................. 41
Table S1. Descriptive characteristics of environmental factors of interest in Pará, 2007-2019....41
Table S2. Annual Multivariate Analyses of Climatologic and Sociologic Factors with Cutaneous Leishmaniasis Incidence in Pará, Brazil, 2007-2019. .................................................................. 42
Figure S1. Highest and Lowest Annual Cutaneous Leishmaniasis Incidence by Reporting Municipality, in Pará, Brazil, 2007-2019......................................................................................44
Figure S2. Comparative Raw and Aspatially Smoothed Incidence Rates of Cutaneous Leishmaniasis, Pará, Brazil, 2007-2019........................................................................................45
Figure S3. Comparative Raw and Spatially Smoothed Incidence Rates of Cutaneous Leishmaniasis, Pará, Brazil, 2007-2019........................................................................................46
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