Aug 2026· Revista Brasileira de Psiquiatria· 0 citations
Medicine
TL;DR
Investigate spatial and temporal distribution of suicide mortality across the Regional Health Care Networks of São Paulo State, Brazil, from 2012 to 2022, evaluating associations with mental health service availability, psychiatric workforce density, and socioeconomic indicators to emerge as key modifiable factors.
Abstract
Objective
Investigate spatial and temporal distribution of suicide mortality across the Regional Health Care Networks of São Paulo State, Brazil, from 2012 to 2022, evaluating associations with mental health service availability, psychiatric workforce density, and socioeconomic indicators.
Methods
Longitudinal retrospective ecological study using annual data from 19 Regional Health Care Networks. Suicide mortality (ICD-10 X60-X84) rates per 100,000 inhabitants were analyzed using descriptive epidemiology, exploratory spatial data analysis, and fixed-effects panel regression models with spatial error specifications and one-year lagged independent variables.
Results
Suicide rates increased from 4.8 to 6.3 per 100,000 (32%). Female aged 10-14 years experienced a 332% increase. Spatial clustering revealed persistent high-risk areas in inland regions. In panel regression models (within-R² = 0.53), psychiatrist density in the public health system demonstrated a protective association (β = -0.20, p < 0.05), as did psychiatric bed rates in lagged models (β = -0.01, p < 0.05). Psychosocial Care Centers coverage showed no significant association. GDP per capita was positively associated with suicide rates.
Conclusions
Psychiatric workforce availability and acute care capacity emerge as key modifiable factors. Increase among female adolescents and persistent geographic disparities warrant targeted prevention strategies. Findings provide actionable evidence for suicide prevention resource allocation in middle-income settings.
Abstract Objective: To describe the temporal and spatial distribution of cardiovascular disease mortality in Brazil from 2003 to 2023. Methods: A time series and spatial analysis study was conducted using secondary data from the Mortality Information System run by the Brazilian Unified Health System Department of Information Technology, including all deaths from circulatory system diseases. Sociodemographic characteristics were analyzed and standardized mortality rates per 100,000 inhabitants were calculated. The temporal trend was assessed using joinpoint regression, with estimated annual percentage change. The spatial analysis considered average municipal rates, both unadjusted and also smoothed by the local empirical Bayesian method, in addition to global and local spatial autocorrelation. Results: 7,088,623 cardiovascular disease deaths were recorded in Brazil between 2003 and 2023, with predominance in males and higher mortality rates among the elderly and people with low levels of education. The highest rates were observed in the Southeast (190.14/100,000) and Southern (187.59/100,000) regions, while the Northern (APC 2003-2008 4.38; APC 2008-2023 2.33) and Northeast (APC 2003-2007 8.15; APC 2007-2023 1.11) regions showed an increasing trend over the period (p-value<0.001). Global Moran’s I (0.02; p-value<0.05) indicated weak but statistically significant positive spatial autocorrelation. Local analysis revealed clusters of high mortality concentrated mainly in municipalities of Mato Grosso and Goiás states, while areas of low mortality predominated in the Northern region and on the Northeast coast. Conclusion: Cardiovascular disease mortality in Brazil showed heterogeneous distribution in time and space.
Francisca Vaneska Lima Nascimento, Ítalo Rigoberto Cavalcante Andrade, Lara Lídia Ventura Damasceno et al.· Epidemiologia e Serviços de...· 0 citations
Summary Background Tuberculosis remains a major cause of preventable mortality in Brazil, marked by pronounced social and territorial inequalities. Evidence remains limited on how socioeconomic conditions and health system characteristics are associated with tuberculosis mortality across age groups in high-burden settings such as São Paulo state. This study aimed to examine the spatial and temporal associations of these factors with tuberculosis mortality across municipalities in the State of São Paulo, Brazil. Methods We conducted a population-based ecological study in São Paulo, Brazil. All TB deaths reported to the Mortality Information System from 2020 to 2024 were included. Socioeconomic, demographic and health system factors were selected based on a conceptual framework. Variables associated with TB mortality were assessed using Generalized Additive Models for Location, Scale, and Shape, with spatial smoothing. Findings The analysis included 38,700 municipality-month observations. In the final spatial GAMLSS model, proportions of household crowding (>2 residents/bedroom) and elderly population (>59 years) were associated with 3.25% and 5.92% increases in expected TB mortality for each one percentage-point increase, respectively. In contrast, each one percentage-point increase in primary health care coverage was associated with a 0.30% decrease in expected TB mortality. The fitted spatial effect indicated higher expected TB mortality along coastal and central regions, and lower expected mortality in the northwestern region. Interpretation Tuberculosis mortality in São Paulo is shaped by persistent socioeconomic and territorial inequalities, with distinct patterns across age groups. These findings highlight the need for strategies that address structural vulnerability and strengthen primary health care to reduce avoidable tuberculosis-related deaths. Funding This work was supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior–Brasil and São Paulo State Research Foundation (FAPESP).
Y. M. Alves, Reginaldo Bazon Vaz Tavares, Nathália Zini et al.· The Lancet Regional Health -...· 0 citations
INTRODUCTION
The Zika epidemic was first reported in Brazil in 2015. Since then, several factors have sustained the virus transmission chain in the country. This study aimed to describe the epidemiological profile and temporal trends, as well as to identify significant spatial and spatiotemporal clusters of Zika in Brazil between 2016 and 2023.
METHODS
Ecological study including confirmed Zika cases in Brazil from 2016 to 2023. Data were extracted from the National Notifiable Diseases Information System. Sociodemographic variables (age, sex, race/ethnicity, education level, and pregnancy status) were collected, along with incidence rates. Analyses were conducted in three steps: (1) description of the epidemiological profile; (2) temporal analysis: Joinpoint regression modeling was applied to identify trends and the Average Annual Percent Change (AAPC) was calculated with 95% confidence intervals and 5% significance level; (3) spatial analysis: spatial dependence among municipalities was assessed using the Global Moran's I index, followed by spatial scan statistics to identify spatial clusters of virus transmission, using both purely spatial and spatiotemporal analyses.
RESULTS
A total of 176,122 cases were reported during the study period. Among them, 42.27% (n = 74,458) were aged 20-39 years, 66.96% (n = 117,945) were female, and 34.92% (n = 61,513) were mixed-race. A decreasing trend in incidence rates was observed in Brazil (AAPC - 36.55%; p < 0.001), with disparities across states. Fifteen out of 27 states showed a downward trend. Rio Grande do Norte was the only state to exhibit an increasing incidence trend and was also identified as the area with the highest relative risk of Zika infection in the country (RR = 12.1; p < 0.001). In the spatio-temporal analysis, the cluster with the highest relative risk (RR 31.08; p < 0.001) included 2,770 municipalities across the North, Northeast, Southeast, and Central-West regions.
CONCLUSION
Zika cases predominated among adults, females, and mixed-race individuals. In Brazil, the overall incidence rate showed a decreasing trend during the study period. The Northeast and Central-West regions had the largest number of clusters, highlighting the need to strengthen surveillance activities in these areas to reduce transmission rates.
Marcos César de Souza Santos, Paula Esbaltar de Oliveira, Phoebe Silva van Emmerik et al.· Virology Journal· 0 citations
Abstract Objectives: to analyze the spatial distribution and factors associated with hospitalizations for abortion in Brazil from 2020 to 2023. Methods: an ecological study of hospitalizations for abortion across the Brazilian Federative Units among women aged 10-49 years and their association with socioeconomic, demographic, and health indicators analyzed at the aggregate level. Public hospitalization and sociodemographic data were used. Spatial autocorrelation was assessed using Moran’s I index, and associations were investigated using ordinary least squares (OLS) regression, with assessment of spatial dependence in the residuals. Results: a total of 700,926 hospitalizations for abortion were analyzed, with rates ranging from 1,373.14 to 1,843.10 per 100,000 women, concentrated in Federative Units located in the North and Northeast regions. Spatial clusters were identified in all regions. Associations were observed between hospitalization rates for spontaneous abortion, vulnerability to poverty, and the percentage of hospitalizations among Black individuals; hospitalizations for medically indicated abortion were associated with the average income of employed women and the maternal mortality rate; and hospitalizations for other pregnancies ending in abortion were associated with fertility. Conclusions: the results highlight regional inequalities and suggest that socioeconomic and health factors are related to hospitalization patterns observed at the aggregate level. These associations should be interpreted as exploratory and hypothesis-generating. The findings reinforce the need for public policies focused on reproductive health.
Leticia Furlan de Lima Prates, Natan Nascimento de Oliveira, Lays Silva de Azevedo et al.· Revista Brasileira de Saúde...· 0 citations
Depressive disorders impose a substantial global burden, yet the spatiotemporal distribution of depression-related service use in Thailand remains unexamined. This study aimed to examine the spatiotemporal trends and geographic clustering of depression-related mental health service attendance across Thailand’s 77 provinces from 2018 to 2023.This retrospective study analysed province-level mental health service attendance rates (ICD-10: F32, F33, F34.1, F38, F39) across all 77 Thai provinces from 2018 to 2023. Attendance rates per 100,000 population were derived from Department of Mental Health administrative data. Temporal trends were assessed using Friedman and Wilcoxon signed-rank tests; and spatial structure using global Moran’s I and Local Indicators of Spatial Association (LISA) with a queen contiguity weights matrix (99,999 permutations) in GeoDa. National mean attendance rose 58.3% from the 2019 pre-pandemic baseline (429 per 100,000) to 679 in 2023 (Friedman χ²(5) = 204.9, p < 0.001), with attendance increasing even during COVID-19 restrictions. Global Moran’s I shifted from non-significant positive clustering (2018-2021) to significant spatial dispersion in 2022 (I = -0.155, p = 0.031). LISA revealed a transition from mild northern hotspots toward a post-pandemic checkerboard of spatial outliers, with Low-Low clusters disappearing entirely by 2022. These findings indicate substantial service expansion alongside emerging geographic fragmentation, underscoring the need for spatially targeted mental health policy in Thailand.
Tay Zar Lin, V. Punyapornwithaya, Pallop Siewchaisakul et al.· BIO Web of Conferences· 0 citations
INTRODUCTION
Suicide is a complex public health issue influenced by a range of psychological, social, and environmental factors. It displays marked spatial and temporal variation, with certain regions consistently experiencing higher rates, while temporal trends fluctuate over years and seasons. Understanding both dimensions is important; therefore, adopting a spatio-temporal approach enables a more comprehensive analysis.
METHODOLOGY
Geocode data on suicide-related calls (N = 82,816) from the Valencian Community, Spain, between 2013 and 2023 were provided by the Valencian Regional Government. We used a Bayesian spatio-temporal Poisson regression modeling with an integrated nested Laplace approximation (INLA) to identify the spatial and temporal distribution of suicide-related calls.
RESULTS
The study revealed a higher incidence of suicide-related calls in urban areas with a lower aging index, greater residential instability, and a higher percentage of one-person households. A clear seasonal pattern emerged, with the fewest calls occurring in the winter months, particularly in February, and most calls occurring from May to September. The spatial distribution of relative risk is presented in the corresponding map, highlighting marked geographic disparities.
CONCLUSION
The observed spatial clustering, sociodemographic correlates, and strong seasonal peaks in suicide-related calls highlight the importance of incorporating spatio-temporal evidence into the design of timely, place-based suicide prevention and community response efforts.
María Montagud-Andrés, Miriam Marco, A. López-Quílez et al.· Archives of Suicide Research· 0 citations
