Spatial interaction of covid-19 and tuberculosis in Brazil: syndemic cluster evidence
1
Department of Maternal and Child Nursing and Public Health, Ribeirão Preto School of Nursing at University of São Paulo, Ribeirão Preto, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A1396
ABSTRACT
INTRODUCTION:
The covid-19 pandemic has intensified existing social and health inequities, particularly in low- and middle-income countries. In Brazil, tuberculosis (TB) faced additional challenges during the pandemic. This study aimed to identify areas with spatial dependence between covid-19 and TB outcomes, incorporating the Social Progress Index (SPI) as a proxy for social vulnerability.
METHODS:
Ecological study using TB cases and deaths from TBWeb and covid-19 data from the Coronavirus Panel, covering municipalities in São Paulo State, Brazil, from February 2020 to December 2023. Notification and mortality rates for both diseases were calculated. Bivariate Local Moran’s I was applied to assess spatial autocorrelation between TB and covid-19 rates and the SPI.
RESULTS:
There were 36,145 TB cases and 5,389,217 COVID-19 cases, with 2,700 and 168,223 deaths, respectively. Bivariate spatial analysis revealed heterogeneous spatial dependencies across the state. High-High clusters for TB and COVID-19 incidence (Map A) and mortality (Map B) were mainly observed in northern and central regions. TB mortality also overlapped spatially with COVID-19 outcomes (Maps C and D), especially in the northwest and coastal areas. Municipalities with low SPI and high TB mortality (Map E) were mostly along the southeastern coast. Similarly, low SPI and high COVID-19 incidence (Map F) were found in the São Paulo metropolitan area and southern municipalities. These patterns reflect a syndemic interaction shaped by social disparities. Figure 1 – Bivariate spatial autocorrelation between COVID-19 incidence and TB incidence and mortality rates, and Social Progress Index, the state of São Paulo, Brazil (2020–2023).
CONCLUSIONS:
The intersection of TB, covid-19, and social vulnerability reflects a syndemic process, in which the co-occurrence and interaction of diseases are driven by structural inequalities. Recognizing these overlapping spatial patterns and their links to social conditions is essential to inform equitable and integrated public health responses to eliminate TB.
The covid-19 pandemic has intensified existing social and health inequities, particularly in low- and middle-income countries. In Brazil, tuberculosis (TB) faced additional challenges during the pandemic. This study aimed to identify areas with spatial dependence between covid-19 and TB outcomes, incorporating the Social Progress Index (SPI) as a proxy for social vulnerability.
METHODS:
Ecological study using TB cases and deaths from TBWeb and covid-19 data from the Coronavirus Panel, covering municipalities in São Paulo State, Brazil, from February 2020 to December 2023. Notification and mortality rates for both diseases were calculated. Bivariate Local Moran’s I was applied to assess spatial autocorrelation between TB and covid-19 rates and the SPI.
RESULTS:
There were 36,145 TB cases and 5,389,217 COVID-19 cases, with 2,700 and 168,223 deaths, respectively. Bivariate spatial analysis revealed heterogeneous spatial dependencies across the state. High-High clusters for TB and COVID-19 incidence (Map A) and mortality (Map B) were mainly observed in northern and central regions. TB mortality also overlapped spatially with COVID-19 outcomes (Maps C and D), especially in the northwest and coastal areas. Municipalities with low SPI and high TB mortality (Map E) were mostly along the southeastern coast. Similarly, low SPI and high COVID-19 incidence (Map F) were found in the São Paulo metropolitan area and southern municipalities. These patterns reflect a syndemic interaction shaped by social disparities. Figure 1 – Bivariate spatial autocorrelation between COVID-19 incidence and TB incidence and mortality rates, and Social Progress Index, the state of São Paulo, Brazil (2020–2023).
CONCLUSIONS:
The intersection of TB, covid-19, and social vulnerability reflects a syndemic process, in which the co-occurrence and interaction of diseases are driven by structural inequalities. Recognizing these overlapping spatial patterns and their links to social conditions is essential to inform equitable and integrated public health responses to eliminate TB.
| eISSN: | 2654-1459 |
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