Indicador de risco de óbito de pacientes com AIDS no município de Campinas sob uma abordagem de modelos espaço-temporais em análise de sobrevivência
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Data
2018-06-04
Autores
Mota, Thiago Santos [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O objetivo principal desta tese foi avaliar a sobrevida e o risco espacial de óbito de pacientes portadores de HIV/AIDS em três períodos de tempo, por meio de modelos de sobrevida espaço-temporais. A justificativa desse estudo se deve a lacuna de trabalhos na área de epidemiologia que abordem simultaneamente técnicas estatísticas de análise espacial e sobrevivência na análise de dados de AIDS. Essas técnicas são úteis para um melhor entendimento sobre a epidemia, para auxiliar no monitoramento clínico, avaliar a mortalidade e obter os fatores de risco que influenciam na sobrevida de pacientes portadores de HIV/AIDS. Os dados foram obtidos do Sistema de Informação de Agravos de Notificação (SINAN) e dos óbitos que constam no banco de dados do sistema de informação sobre mortalidade (SIM) de moradores de Campinas. O banco dados foi dividido em três coortes retrospectivas, sendo a primeira composta de 286 indivíduos notificados nos primeiros anos da epidemia de 1980 a 1990 (coorte 1), uma segunda coorte com 1456 indivíduos notificados de 1996 a 2000 e uma terceira coorte com 1342 indivíduos notificados de 2001 a 2005 (coorte 3). Nestas coortes o tempo de seguimento médio foi de 10 anos. Na modelagem utilizou-se duas abordagens, na primeira, bayesiana, ajustou-se um modelo semi-paramétrico bayesiano empregando o método de Aproximação de Laplace Aninhada e Integrada (INLA) agregando as localizações das residências dos indivíduos que pertenciam ao mesmo setor censitário. Na segunda abordagem, frequentista, utilizou-se uma extensão do modelo de risco proporcionais, incorporado nos Modelos Lineares Aditivos Generalizados (GAM), considerando uma função de suavização com as localizações espaciais dos indivíduos (latitude e longitude). Como resultado, obteve-se os mapas de risco que apontaram tendência de queda da mortalidade e evidenciaram os setores que apresentaram maior e menor risco, além disso obteve-se os fatores de risco de óbito dos indivíduos portadores de HIV/AIDS. As duas abordagens diferem em alguns resultados, mas indicam a diminuição do risco de morte por AIDS nos últimos anos, após o acesso à terapia anti-retroviral altamente ativa. Os mapas e os fatores de risco obtidos orientam possíveis ações e monitoramento da doença no município.
The main objective of this thesis was to evaluate the survival and spatial risk of death of patients with HIV/AIDS in three periods of time, through of spatio--temporal survival models. The justification for this study is due to a gap in work in the area of the epidemiology that simultaneously addresses statistical techniques of spatial analysis and survival in the analysis of AIDS data. These techniques are useful for a better understanding of the epidemic, to assist in clinical monitoring, to evaluate mortality and to obtain the risk factors that influence the survival of patients with AIDS. The data were obtained from the Information System for Notifiable Diseases (SINAN) and from the deaths in the database of the mortality information system (SIM) of residents of Campinas. The data was divided into three retrospective cohorts, the first consisting of 286 individuals reported in the first years of the epidemic from 1980 to 1990 (cohort 1), a second cohort with 1456 individuals reported from 1996 to 2000 and a third cohort with 1342 individuals reported from 2001 to 2005 (cohort 3). In these cohorts the mean follow-up time was 10 years. In the modeling we used two approaches, in the first, Bayesian, adjusted a Bayesian semi--parametric model using the Approximation Laplace Nested and Integrated (INLA) aggregating the locations of the residences of individuals belonging to the same census sector. In the second approach, frequentist, we used a proportional extension of the risk model, incorporated Generalized Additive Models (GAM), considering a spatial locations of individuals (latitude and longitude). As a result, we obtained the risk maps that indicated a tendency of mortality decrease and evidenced the sectors that presented higher and lower risk, in addition to the risk factors were obtained from individuals with HIV/AIDS. The two approaches differ in some indicate a reduction in the risk of death from AIDS in recent years, after access to highly active antiretroviral therapy. The maps and the risk factors obtained guide possible actions and monitoring of the disease in the municipality.
The main objective of this thesis was to evaluate the survival and spatial risk of death of patients with HIV/AIDS in three periods of time, through of spatio--temporal survival models. The justification for this study is due to a gap in work in the area of the epidemiology that simultaneously addresses statistical techniques of spatial analysis and survival in the analysis of AIDS data. These techniques are useful for a better understanding of the epidemic, to assist in clinical monitoring, to evaluate mortality and to obtain the risk factors that influence the survival of patients with AIDS. The data were obtained from the Information System for Notifiable Diseases (SINAN) and from the deaths in the database of the mortality information system (SIM) of residents of Campinas. The data was divided into three retrospective cohorts, the first consisting of 286 individuals reported in the first years of the epidemic from 1980 to 1990 (cohort 1), a second cohort with 1456 individuals reported from 1996 to 2000 and a third cohort with 1342 individuals reported from 2001 to 2005 (cohort 3). In these cohorts the mean follow-up time was 10 years. In the modeling we used two approaches, in the first, Bayesian, adjusted a Bayesian semi--parametric model using the Approximation Laplace Nested and Integrated (INLA) aggregating the locations of the residences of individuals belonging to the same census sector. In the second approach, frequentist, we used a proportional extension of the risk model, incorporated Generalized Additive Models (GAM), considering a spatial locations of individuals (latitude and longitude). As a result, we obtained the risk maps that indicated a tendency of mortality decrease and evidenced the sectors that presented higher and lower risk, in addition to the risk factors were obtained from individuals with HIV/AIDS. The two approaches differ in some indicate a reduction in the risk of death from AIDS in recent years, after access to highly active antiretroviral therapy. The maps and the risk factors obtained guide possible actions and monitoring of the disease in the municipality.
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Palavras-chave
AIDS, Distribuição espacial, HAART, INLA, Mortalidade