CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Apesar de avanÃos cientÃficos no tratamento ao HIV e de polÃtica pÃblica especÃfica à populaÃÃo infectada, a aids se constitui em sÃrio problema de saÃde, que acomete grupos mais vulnerÃveis. Desta forma, ao tratar de pessoas vivendo com HIV à necessÃrio levar em conta os determinantes sociais relacionados ao processo de saÃde-doenÃa. Objetiva-se analisar a distribuiÃÃo espacial de pacientes com aids no Estado do CearÃ, Brasil, e sua associaÃÃo com determinantes sociais de saÃde. Estudo ecolÃgico transversal, considerou-se indivÃduos com aids, de idade igual ou superior a 13 anos, residentes no CearÃ, notificados entre 2001 e 2011 pelo Sistema de InformaÃÃo de Agravos de NotificaÃÃo. Trabalhou-se com variÃveis sociodemogrÃficas obtidas na Secretaria da SaÃde do Estado, dados socioeconÃmicos, ambientais e de saÃde do Instituto Brasileiro de Geografia e EstatÃstica, do Departamento de InformÃtica do Sistema Ãnico de SaÃde do Brasil e do Departamento de AtenÃÃo BÃsica. ConstruÃram-se indicadores epidemiolÃgicos e sociais baseados no Modelo TeÃrico de DeterminaÃÃo Social sugerido por Whitehead e Dahlgren. Para anÃlise dos dados individuais empregou-se o software SPSS 20.0. Testes foram aplicados para comparaÃÃo das proporÃÃes (exato de Fisher ou qui-quadrado de Pearson), comparaÃÃo de mÃdias (t de Student), correlaÃÃo entre variÃvel dependente e suas regressoras (teste de Pearson) e teste para aferir a normalidade da variÃvel dependente (Shapiro-Wilk). Foram consideradas estatisticamente significantes anÃlises inferenciais de ρ inferior a 0,05. Para dados socioambientais e de saÃde foram utilizados mÃtodos de geoprocessamento e de geoanÃlise. Para identificaÃÃo de aglomerados espaciais, calculou-se taxa mÃdia de aids do perÃodo e relacionada com o mapa vetorial do CearÃ, atravÃs do programa ArcGis10.1. AutocorrelaÃÃo espacial foi verificada pelo Ãndice de Moran. O Modelo de RegressÃo Linear Global foi Ãtil para anÃlise multivariada. Foram construÃdos mapas do risco relativo à formaÃÃo de aglomerados de aids ao longo da sÃrie temporal. Obteve-se aprovaÃÃo do Comità de Ãtica da Secretaria da SaÃde do Estado, sob protocolo n 203.911. A aids à crescente no CearÃ, com maioria masculina, adulta, residente na Capital. Foi observado processo de feminizaÃÃo, juvenizaÃÃo e interiorizaÃÃo da epidemia. O uso de drogas à prevalente entre jovens e pessoas de baixa escolaridade. Ocorre tendÃncia crescente da doenÃa entre pessoas com sete a onze anos de estudo, e diferenÃa estatÃstica significativa entre os sexos. A Rede Social de Apoio e de SaÃde Especializada para aids concentra-se na RegiÃo Metropolitana do Estado. Clusters de aids com altas taxas foi verificada na RegiÃo LitorÃnea e em Ãreas prÃximas à fronteira do PiauÃ, provavelmente vinculados ao turismo e aos processos migratÃrios. As taxas de aids foram associadas com a maioria dos indicadores socioeconÃmicos estudados. Observou-se relaÃÃo positiva entre aids e desigualdades econÃmicas. Foi verificada associaÃÃo inversa entre o agravo e a atenÃÃo primÃria. Constatou-se risco para clusters de aids primeiramente nos SertÃes do Estado e maior risco relativo em municÃpios do Noroeste Cearense ao longo da sÃrie temporal. Segundo se conclui, a aids no Cearà possui Ãreas de dependÃncia espacial e as disparidades socioeconÃmicas e de acesso à saÃde geram determinaÃÃes preponderantes ao adoecimento pelo HIV. / Despite scientific advances in HIV treatment and the specific public policy for the infected population, aids represents a severe health problem that affects more vulnerable groups. Therefore, when treating HIV-positive people, the social determinants of the health-disease process need to be taken into account. The goal is to analyze the spatial distribution of aids patients in the State of CearÃ, Brazil, and its association with social determinants of health. In this cross-sectional ecological study, individuals with aids aged 13 years or older were considered, who lived in Cearà and had been notified between 2001 and 2011 in the Brazilian Case Registry Database. Sociodemographic variables were used that were collected from the State Health Secretary; socioeconomic, environmental and health data from the Brazilian Institute of Geography and Statistics, from the Informatics Department of the Brazilian Unified Health System and from the Primary Healthcare Department. Epidemiological and social indicators were constructed based on the Theoretical Model of Social Determination suggested by Whitehead and Dahlgren. For individual data analysis, SPSS 20.0 software was employed. Tests were applied for comparison of proportions (Fisherâs exact or Pearsonâs chi-square), comparison of means (Studentâs t), correlation between dependent variable and its regressor variables (Pearson) and a test to verify the normality of the dependent variable (Shapiro-Wilk). Inferential analyses with ρ inferior to 0.05 were considered statistically significant. For socio-environmental and health data, geoprocessing and geo-analysis methods were used. To identify spatial clusters, the mean aids rate for the period was calculated and related to the vector map of CearÃ, using the software ArcGis10.1. Spatial self-correlation was verified through Moranâs index. The Global Linear Regression Model was useful for multivariate analysis. Risk maps were constructed for the formation of aids clusters throughout the time series. Approval was obtained from the Ethics Committee of the State Health Secretary under protocol 203.911. Aids is increasing in CearÃ, with a mostly male, adult population living in the state capital. It was observed that the epidemic is expanding among women, young people and in the interior of the state. Drugs use prevails among young people and people with low education levels. A growing trend of the disease is observed among people with seven to 11 years of education, with a statistically significant difference between the sexes. The Social Support and Specialized Health Network for aids is concentrated in the Metropolitan Region of the State. Aids clusters with high rates were verified in the Coastal Region and in areas close to the border with the State of PiauÃ, probably linked to tourism and migration processes. The aids rates were associated with most of the socioeconomic indicators studies. A positive relation was observed between aids and economic inequalities. An inverse association was verified between the problem and primary care. The risk of clusters was verified primarily in the hinterland of the State and a greater relative risk in cities in the Northeast of Cearà throughout the time series. As concluded, aids in Cearà is marked by areas of spatial dependence and the disparities in socioeconomic and health access conditions produce preponderant determinations for illness caused by HIV.
| Identifer | oai:union.ndltd.org:IBICT/oai:www.teses.ufc.br:7467 |
| Date | 14 October 2013 |
| Creators | Simone de Sousa Paiva |
| Contributors | Marli Teresinha Gimeniz GalvÃo, Ana Karina Bezerra Pinheiro, Cynthia Romariz Duarte, Raimunda Hermelinda Maia Macena, Maria do Socorro Cavalcante |
| Publisher | Universidade Federal do CearÃ, Programa de PÃs-GraduaÃÃo em Enfermagem, UFC, BR |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFC, instname:Universidade Federal do Ceará, instacron:UFC |
| Rights | info:eu-repo/semantics/openAccess |
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