Geographical distribution and health care disparities of scorpion stings in Brazil
Background: Scorpion stings have become an emerging public health concern in Brazil, with a tripling of cases from 2013 to 2017. Deaths also increased by 50% during the same period, mostly impacting the elderly and children. Preventing the morbidity and mortality related to these stings depends on timely access to appropriate care and administration of antivenom. Although Brazil’s national health system provides universal healthcare at no direct cost to patients, socioeconomic inequities still greatly impact outcomes. Our study objectives were 1) to determine the prevalence of venomous scorpion stings in Brazil using a geographic information system (GIS); and 2) to evaluate geospatial associations between mortality, clinical complications, and socioeconomic development. Methods: Using data from 2010 to 2016 in Brazil’s national healthcare databases, we identified areas of high scorpion sting prevalence, mortality and incidence of clinical complications through GIS. Complications were defined as localized to the envenomation site or systemic sequelae of envenomation. These outcomes were spatially associated with geographic location and socioeconomic development as measured by the Human Development Index (HDI). Areas with a higher density of stings and outcomes associated with HDI were identified with Geographically Weighted Regression. esults: The Southern and Northern regions had the highest prevalence of scorpion stings (Moran’s I = 0.375). However, mortality and morbidity were concentrated in the Southeast and the state of Amazonas. Lower access to scorpion antivenom was observed in the North and Northeast regions, as well as the coastal area of the Southeast region. The highest volume of cases with treatment delays (> 3 hours to reach the hospital) were concentrated in the Northern region, mostly in the Amazon forest area, as well as in the interior area of the Northeast region. Delayed access to care was mostly associated with mortality and morbidity in the Northern and Northeast regions. In the Southeast region, lower literacy levels and lower income were associated with mortality and morbidity.
Snake envenomation; snake bite; Brazil; geographic information systems
Wen FH, Monteiro WM, Scheidt J.F., Andrade L., Ye J., Staton C.A., et al. Geographical distribution and health care disparities of scorpion stings in Brazil. Toxicon. 2020 July;182(supl.1):S24-S25. doi:10.1016/j.toxicon.2020.04.060.
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