Resumen

VALDEZ TAH, Alba Rocio  y  ROMERO, David. Geography of Chagas Disease in Yucatan: Socioeconomic and Demographic Determinants at the Municipal Level. Invest. Geog [online]. 2024, n.113, e60801.  Epub 30-Jul-2024. ISSN 2448-7279.  https://doi.org/10.14350/rig.60801.

This geographic study on the epidemiology of Chagas disease (CD) highlights the importance of analyzing its spatial distribution to understand its spread. Factors such as sociodemography and the environmental and economic contexts are considered to identify high-prevalence areas. Given the transmission through triatomine insects, the study also includes entomological aspects. The study focused on the state of Yucatan, hypothesizing differences at the municipal level in the distribution of populations and the socioeconomic conditions that influence new infections with Trypanosoma cruzi. The period studied was established based on the analysis of the official statistics available about new cases of infection with T. cruzi from 2003 and the entomological indicators from 2015, both until 2022. The methodology included data by municipality loaded into a geographic information system per unit of time, followed by calculating incidence and prevalence rates. The nominal municipal marginalization index was used to assess poverty dimensions. The information was integrated with socio-demographic data from Mexico’s National Institute of Geography and Statistics (Instituto Nacional de Geografía y Estadística, INEGI) and the National Population Council (Consejo Nacional de Población, CONAPO). Finally, we conducted a correlation analysis applying a non-parametric test between entomological and socio-demographic variables, estimating the interdependence of entomological and epidemiological variables and their relationship with social factors. CD is ubiquitous in Yucatán, being more prevalent in the city of Mérida and its metropolitan area, as well as in the main urban centers and surrounding municipalities with a high population density to the south and east of the state (mainly in the municipalities of Ticul and Valladolid). The temporal distribution of the triatomine insects varied seasonally, with greater detection and collection in May 2016 and 2017. A time series analysis found no relationship between epidemiological and entomological variables. The significant correlation of epidemiological variables with the number of triatomine insects indicates the medical importance of vector transmission of the parasite in Yucatán. The evidence found suggests that living conditions - the most important socioeconomic and demographic variables at the municipal level as drivers for the vector transmission of T. cruzi and CD - were unpaved floor in houses, percentage of illiterate population aged 15 years and older, and overcrowding in households, all of them proxies of the nominal marginalization index, which was also significantly correlated with the infection rate in humans. Similarly, the correlation analysis suggests the effect of the interaction of urbanization processes, environmental modification, and the increasing human population density on the epidemiology of CD in Yucatán. In the Discussion, we argue that urbanization might influence the exposure of people to triatomine insects and affect the social vulnerability to face the threat of T. cruzi, either because it affects the household space, as well as the prevention and the availability of assets and inputs related to access to comprehensive healthcare. We also discuss the marked differences in epidemiological and entomological aspects between adjacent or similar municipalities, beyond the ecological characteristics, based on differences in the operation efficacy of monitoring programs and the urban location of technical-administrative units, and the main clinical centers and laboratories of the healthcare sector in the interior of the state. The main limitations of the study were the complexity of considering poverty as a dynamic and multidimensional process and the underreporting of CD cases due to its political and institutional neglect. This study provided a first approach to answering questions about the epidemiological situation of CD as a public health problem in Yucatán and knowing its spatial distribution. Furthermore, the present study challenges the geographically focused vision of government actions, which have addressed mainly vector control, and suggests that, due to the relationship of CD with the living conditions and socio-demographic and urbanization phenomena, this issue should be understood and approached from a broader and comprehensive perspective in public policy, including health aspects, given the complexity of the phenomenon, in parallel with the urgent need to provide access to comprehensive healthcare for those affected.

Palabras llave : American trypanosomiasis; epidemiology; Triatoma dimidiata; Spearman correlation; neglected tropical diseases.

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