Distribuição espaço-temporal da prevalência de pé diabético e amputações por diabetes no Brasil antes e após a Lei nº 11.347/06

Abstract

The demographic transition that has taken place in the world and in Brazil brings with it a change in the pattern of diseases found in populations. The chronic noncommunicable diseases (NCDs) has appeared rather prominently in this epidemiological transition scenario, and its morbidities have affected considerably individuals, such as Diabetes Mellitus (DM) associated with diabetic foot and amputations. The aim of study was analyze the space-time distribution of prevalence rates of diabetic foot and amputations for diabetes mellitus in Brazil, before and after the law 11.347/06, which talking about the free distribution of medicines and materials for its implementation and monitoring of blood glucose to DM. This is an ecological study, which used as units of analysis 161 Urban Articulation Regions intermediate and DATASUS data of individuals over 40 years in 2003- 2012. We used the Global Moran and Local Moran tests and joinpoint analysis of rates in the country. We conducted bivariate spatial analysis of the main variables and primary care coverage rates (professionals/institutions). The results showed that in 2003, the prevalence rates of diabetic foot and amputations were higher (2.47/100.000 and 1.66/100.000, respectively). There was an annual reduction of 9.4% in the prevalence of diabetic foot and 7.3% in the amputation rate from 2003 to 2012. There was a higher spatial concentration of diabetic foot rates in the North, Northeast and Midwest. There was negative autocorrelation when performed bivariate analysis with the rate of establishments in primary care (ranging from I= -0,07 a -0,12, p< 0,05). This suggests important relationship between the small number of establishments in the regions and the highest prevalence. It concludes that despite the decrease in prevalence rates, it was not possible to identify direct influence of the law on reduced rates of diabetic foot and amputations for diabetes mellitus in Brazil.