# Space-Time scan of tuberculosis indicators in Northeast Brazil: an ecological and time-series study over 20 years (2001-2020)

## TL;DR

This study analyzed 20 years of tuberculosis data in Brazil's Northeast region to identify trends and clusters, revealing persistent challenges in controlling the disease.

## Contribution

The study provides a detailed space-time analysis of PTB in Brazil's Northeast, identifying high-risk clusters and trends in incidence and mortality.

## Key findings

- Pernambuco had the highest PTB incidence and mortality rates in the Northeast region.
- Mortality rates increased across all regions, with an average annual percentage change of 17.4%.
- High-risk clusters were identified in Bahia, Ceará, Maranhão, and coastal areas of Alagoas and Pernambuco.

## Abstract

Tuberculosis (TB) is a persistent infectious disease caused by the Mycobacterium tuberculosis bacillus. Despite being preventable and treatable, TB remains a significant global public health challenge, particularly affecting vulnerable populations such people deprived of liberty, homeless individuals, and those living with HIV/AIDS. In Brazil, regional disparities may influence the prevalence and mortality rates of TB, highlighting the need for comprehensive epidemiological assessments to inform targeted interventions.

This study aimed to evaluate the clinical and epidemiological indicators, temporal trends, and spatial distribution of pulmonary tuberculosis (PTB) in the Northeast region of Brazil.

An ecological and time-series study spanning two decades was conducted using PTB indicators from all nine Federative Units in the Northeast region of Brazil. Temporal trends were assessed using segmented linear regression models, while spatial analysis employed global and local Moran indices to detect clustering patterns. Space-time scanning statistics were also utilized to identify high-risk clusters of PTB cases.

Between 2001 and 2020, a total of 426,110 cases of PTB were reported in the Brazilian Northeast, with a predominant occurrence among individuals aged 20–39 years, non-white individuals, and males. The region exhibited an incidence coefficient of 35.94 cases and a mortality rate of 1.15 per 100,000 inhabitants. Pernambuco emerged with the highest incidence and mortality rates, followed by Sergipe, which also reported the highest proportion of treatment success (72.05%) and interruption or failure (12.77%). While the detection rate remained stable over time, there was a concerning upward trend in mortality rates across all Federative Units, with an average annual percentage change of 17.4%.

The study revealed a heterogeneous distribution of PTB across the Northeast region of Brazil, with notable high-risk clusters identified primarily in Bahia, Ceará, Maranhão, and coastal areas of Alagoas and Pernambuco. The stability in PTB incidence coupled with rising mortality rates and declining cure proportions underscores significant challenges in TB control efforts within the region. These findings underscore the urgent need for targeted interventions and strengthened healthcare systems to achieve Brazil’s goals outlined in the “End TB strategy” endorsed by the WHO.