title: Spatial analysis of avoidable hospitalizations due to tuberculosis in Ribeirao Preto, SP, Brazil (2006-2012).
abstract: OBJECTIVE
  To describe the spatial distribution of avoidable hospitalizations due to tuberculosis in the municipality of Ribeirao Preto, SP, Brazil, and to identify spatial and space-time clusters for the risk of occurrence of these events.
  
  
  METHODS
  This is a descriptive, ecological study that considered the hospitalizations records of the Hospital Information System of residents of Ribeirao Preto, SP, Southeastern Brazil, from 2006 to 2012. Only the cases with recorded addresses were considered for the spatial analyses, and they were also geocoded. We resorted to Kernel density estimation to identify the densest areas, local empirical Bayes rate as the method for smoothing the incidence rates of hospital admissions, and scan statistic for identifying clusters of risk. Softwares ArcGis 10.2, TerraView 4.2.2, and SaTScan™ were used in the analysis.
  
  
  RESULTS
  We identified 169 hospitalizations due to tuberculosis. Most were of men (n = 134; 79.2%), averagely aged 48 years (SD = 16.2). The predominant clinical form was the pulmonary one, which was confirmed through a microscopic examination of expectorated sputum (n = 66; 39.0%). We geocoded 159 cases (94.0%). We observed a non-random spatial distribution of avoidable hospitalizations due to tuberculosis concentrated in the northern and western regions of the municipality. Through the scan statistic, three spatial clusters for risk of hospitalizations due to tuberculosis were identified, one of them in the northern region of the municipality (relative risk [RR] = 3.4; 95%CI 2.7-4,4); the second in the central region, where there is a prison unit (RR = 28.6; 95%CI 22.4-36.6); and the last one in the southern region, and area of protection for hospitalizations (RR = 0.2; 95%CI 0.2-0.3). We did not identify any space-time clusters.
  
  
  CONCLUSIONS
  The investigation showed priority areas for the control and surveillance of tuberculosis, as well as the profile of the affected population, which shows important aspects to be considered in terms of management and organization of health care services targeting effectiveness in primary health care.
authors.affiliation: Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: Mellina
authors.initials: M
authors.lastname: Yamamura
authors.affiliation: Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: Isabela Moreira
authors.initials: IM
authors.lastname: de Freitas
authors.affiliation: Departamento de Enfermagem, Universidade Federal do Maranhão, Imperatriz, MA, Brasil.
authors.forename: Marcelino
authors.initials: M
authors.lastname: Santo Neto
authors.affiliation: Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Francisco
authors.initials: F
authors.lastname: Chiaravalloti Neto
authors.affiliation: Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: Marcela Antunes Paschoal
authors.initials: MA
authors.lastname: Popolin
authors.affiliation: Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: Luiz Henrique
authors.initials: LH
authors.lastname: Arroyo
authors.affiliation: Departamento de Medicina, Universidade Federal do Mato Grosso, Sinop, MT, Brasil.
authors.forename: Ludmila Barbosa Bandeira
authors.initials: LB
authors.lastname: Rodrigues
authors.affiliation: Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: Juliane Almeida
authors.initials: JA
authors.lastname: Crispim
authors.affiliation: Departamento de Enfermagem Materno Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: Ricardo Alexandre
authors.initials: RA
authors.lastname: Arcêncio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006751:Hospital Information Systems; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D062206:Spatial Analysis; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*; D055815:Young Adult