An ecological study mapping socioeconomic inequalities in tuberculosis incidence in a southern state of Brazil

Abstract

Objective: To analyze the spatial patterns and factors associated with tuberculosis incidence in the municipalities of Paraná, Brazil.

Materials and methods: Ecological study examining new tuberculosis cases from 2018 to 2022 in Paraná's 399 municipalities. Incidence coefficients, relative risk, and local indicator of spatial autocorrelation were estimated. Negative binomial models were applied to identify associated factors.

Results: High-risk areas were observed in the coastal/port, north, and northeast regions. The following factors positively influenced tuberculosis incidence: municipal development index (incidence rate ratio [IRR]: 1.07; 95 % confidence interval [95 % CI]: 1.01-1.14), hospitalizations due to inadequate environmental sanitation (IRR: 1.07; 95 % CI: 1.01-1.14), and Gini index (IRR: 1.09; 95 % CI: 1.02-1.16).

Conclusions: Paradoxically, in municipalities with elevated development indices yet marked by socioeconomic disparities-including deficiencies in sanitation-substantial tuberculosis clusters persist. This suggests that income inequality might play a role in perpetuating the incidence even in regions that are otherwise considered developed.

Keywords: Disease mapping; Ecological studies; Negative binomial regression; Socioeconomic vulnerability; Spatial analysis; Tuberculosis.