title: Pulmonary tuberculosis in São Luis, State of Maranhão, Brazil: space and space-time risk clusters for death (2008-2012).
abstract: BACKGROUND
  The objective was to identify space and space-time risk clusters for the occurrence of deaths in a priority city for the control of tuberculosis (TB) in the Brazilian Northeast.
  
  
  METHODS
  Ecological research was undertaken in the City of São Luis/Maranhão. Cases were considered that resulted in deaths in the population living in the urban region of the city with pulmonary TB as the basic cause, between 2008 and 2012. To detect space and space-time clusters of deaths due to pulmonary TB in the census sectors, the spatial analysis scan technique was used.
  
  
  RESULTS
  In total, 221 deaths by TB occurred, 193 of which were due to pulmonary TB. Approximately 95% of the cases (n=183) were geocoded. Two significant spatial clusters were identified, the first of which showed a mortality rate of 5.8 deaths per 100,000 inhabitants per year and a high relative risk of 3.87. The second spatial cluster showed a mortality rate of 0.4 deaths per 100,000 inhabitants per year and a low relative risk of 0.10. A significant cluster was observed in the space-time analysis between 11/01/2008 and 04/30/2011, with a mortality rate of 8.10 deaths per 100,000 inhabitants per year and a high relative risk (3.0).
  
  
  CONCLUSIONS
  The knowledge of priority sites for the occurrence of deaths can support public management to reduce inequities in the access to health services and permit an optimization of the resources and teams in the control of pulmonary TB, providing support for specific strategies focused on the most vulnerable populations.
authors: Centro de Ciências Sociais Saúde e Tecnologia, Universidade Federal do Maranhão, Imperatriz, MA, Brazil.
authors: Marcelino
authors: M
authors: Santos Neto
authors: Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
authors: Mellina
authors: M
authors: Yamamura
authors: Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
authors: Maria Concebida da Cunha
authors: MC
authors: Garcia
authors: Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
authors: Marcela Paschoal
authors: MP
authors: Popolin
authors: Departamento de Medicina, Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil.
authors: Ludmila Barbosa Bandeira
authors: LB
authors: Rodrigues
authors: Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil.
authors: Francisco
authors: F
authors: Chiaravalloti Neto
authors: Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
authors: Inês
authors: I
authors: Fronteira
authors: Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
authors: Ricardo Alexandre
authors: RA
authors: Arcêncio
mesh_terms: D001938:Brazil / Q000453:epidemiology; D006801:Humans; D011446:Prospective Studies; D012959:Socioeconomic Factors; D013029:Space-Time Clustering; D014397:Tuberculosis, Pulmonary / Q000401:mortality*