Patrones espacio-temporales de la mortalidad por enfermedades crónicas no transmisibles sensibles al clima según sexo en Argentina: interpretaciones desde un enfoque sindémico

From a syndemic perspective, chronic noncommunicable diseases (NCDs), adverse climate-environmental exposures, and social inequalities coexist within the same territories. To identify sex-specific spatiotemporal mortality patterns of climate-sensitive NCDs in Argentina and compare them with selected socioenvironmental indicators, an ecological time-series study (511 departments, 2000-2023) was conducted using emerging hotspot analysis of age-standardized mortality rates (ASMRs) for cardiovascular diseases (CVD) and chronic respiratory diseases (CRD). Additionally, cross-sectional associations between ASMRs for the most recent triennium (2021-2023) and climatic-environmental and sociodemographic variables (2022) were examined using multilevel Poisson regression models. Spatiotemporal patterns between 2000 and 2023 differed according to cause and sex. In women, northeastern Argentina concentrated increasing and persistent CVD hotspots in contexts characterized by high temperatures and poverty measured by unmet basic needs in 2022. In the northwest-central region, consecutive and increasing CRD hotspots were identified in areas spatially coincident with moderate PM2.5 concentrations, whereas the metropolitan region, characterized in 2022 by high PM2.5 pollution and urbanization, showed persistent hotspots in women and decreasing hotspots in men during 2000-2023. Direct associations (p<0.001) were observed between ASMRs and mean temperature, PM2.5 concentration, percentage of households with unmet basic needs, and urban housing. These findings suggest ecological associations and territorial overlap among syndemic components linked to NCDs, climate-environmental exposures, and social inequalities, providing relevant evidence to inform public health decision-making and generate hypotheses on the climate-environment-health nexus.