Persistent Social Inequalities in Tuberculosis Incidence in Brazil: A Municipal-Level Ecological Study
1
Public Health, University of Brasilia, Brasilia, Brazil, University of Brasilia, Brasília, Brazil
2
Center for Tropical Medicine. School of Medicine, University of Brasília, Brasília, Brazil, University of Brasilia, Brasília, Brazil
3
CUIDA Chagas Consortium, Oswaldo Cruz Fundation, Rio de Janeiro, Brazil
4
Public Health, Federal University of Pernambuco, Recife, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A1372
ABSTRACT
INTRODUCTION:
Tuberculosis remains strongly associated with social inequalities, functioning as a sentinel event of health inequities. The analysis of its spatial distribution in conjunction with socioeconomic indicators is essential to inform equity-oriented public policies. This study aimed to assess the magnitude and persistence of social inequalities in municipal tuberculosis incidence rates in Brazil according to income inequality.
METHODS:
An ecological study was conducted using Brazilian municipalities as units of analysis. Tuberculosis incidence rates (per 100,000 population) were aggregated into three biennial periods (2001–2002, 2012–2013, and 2023–2024) and spatially smoothed using the Global Empirical Bayes method to reduce random variability. Income inequality was measured using the municipal Gini index (2010). Social inequalities were assessed using simple measures (absolute and relative gaps), gradient-based measures (Slope Index of Inequality [SII] and Relative Index of Inequality [RII]), and concentration measures (absolute and relative concentration indices).
RESULTS:
Across all study periods, tuberculosis incidence was consistently higher in municipalities with greater income inequality. In 2023–2024, the absolute gap was 17.71 (95% CI: 16.86–18.57) cases per 100,000 population, and the relative gap was 1.56 (95% CI: 1.52–1.60). The SII indicated an excess of 25.86 cases per 100,000 population in the most disadvantaged municipalities, while the relative concentration index was −12.1% (95% CI: -12.16%; -12.03%). The relative concentration index was −12.1% (95% CI: −12.16% to −12.03%), demonstrating a marked concentration of tuberculosis in socially vulnerable strata. Similar patterns were identified in 2001–2002 and 2012–2013, demonstrating the persistence of social inequalities over time.
CONCLUSIONS:
Tuberculosis incidence shows a persistent social gradient strongly associated with municipal income inequality. These findings emphasize the need for equity-oriented, intersectoral, and territorially targeted strategies to address tuberculosis and its social determinants in Brazil.
Tuberculosis remains strongly associated with social inequalities, functioning as a sentinel event of health inequities. The analysis of its spatial distribution in conjunction with socioeconomic indicators is essential to inform equity-oriented public policies. This study aimed to assess the magnitude and persistence of social inequalities in municipal tuberculosis incidence rates in Brazil according to income inequality.
METHODS:
An ecological study was conducted using Brazilian municipalities as units of analysis. Tuberculosis incidence rates (per 100,000 population) were aggregated into three biennial periods (2001–2002, 2012–2013, and 2023–2024) and spatially smoothed using the Global Empirical Bayes method to reduce random variability. Income inequality was measured using the municipal Gini index (2010). Social inequalities were assessed using simple measures (absolute and relative gaps), gradient-based measures (Slope Index of Inequality [SII] and Relative Index of Inequality [RII]), and concentration measures (absolute and relative concentration indices).
RESULTS:
Across all study periods, tuberculosis incidence was consistently higher in municipalities with greater income inequality. In 2023–2024, the absolute gap was 17.71 (95% CI: 16.86–18.57) cases per 100,000 population, and the relative gap was 1.56 (95% CI: 1.52–1.60). The SII indicated an excess of 25.86 cases per 100,000 population in the most disadvantaged municipalities, while the relative concentration index was −12.1% (95% CI: -12.16%; -12.03%). The relative concentration index was −12.1% (95% CI: −12.16% to −12.03%), demonstrating a marked concentration of tuberculosis in socially vulnerable strata. Similar patterns were identified in 2001–2002 and 2012–2013, demonstrating the persistence of social inequalities over time.
CONCLUSIONS:
Tuberculosis incidence shows a persistent social gradient strongly associated with municipal income inequality. These findings emphasize the need for equity-oriented, intersectoral, and territorially targeted strategies to address tuberculosis and its social determinants in Brazil.
| eISSN: | 2654-1459 |
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