Summary Background Tuberculosis remains a major cause of preventable mortality in Brazil, marked by pronounced social and territorial inequalities. Evidence remains limited on how socioeconomic conditions and health system characteristics are associated with tuberculosis mortality across age groups in high-burden settings such as São Paulo state. This study aimed to examine the spatial and temporal associations of these factors with tuberculosis mortality across municipalities in the State of São Paulo, Brazil. Methods We conducted a population-based ecological study in São Paulo, Brazil. All TB deaths reported to the Mortality Information System from 2020 to 2024 were included. Socioeconomic, demographic and health system factors were selected based on a conceptual framework. Variables associated with TB mortality were assessed using Generalized Additive Models for Location, Scale, and Shape, with spatial smoothing. Findings The analysis included 38,700 municipality-month observations. In the final spatial GAMLSS model, proportions of household crowding (>2 residents/bedroom) and elderly population (>59 years) were associated with 3.25% and 5.92% increases in expected TB mortality for each one percentage-point increase, respectively. In contrast, each one percentage-point increase in primary health care coverage was associated with a 0.30% decrease in expected TB mortality. The fitted spatial effect indicated higher expected TB mortality along coastal and central regions, and lower expected mortality in the northwestern region. Interpretation Tuberculosis mortality in São Paulo is shaped by persistent socioeconomic and territorial inequalities, with distinct patterns across age groups. These findings highlight the need for strategies that address structural vulnerability and strengthen primary health care to reduce avoidable tuberculosis-related deaths. Funding This work was supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior–Brasil and São Paulo State Research Foundation (FAPESP).
Y. M. Alves, Reginaldo Bazon Vaz Tavares, Nathália Zini et al.· The Lancet Regional Health -...· 0 citations
Abstract Objective To identify space-time risk clusters for cases and deaths from severe acute respiratory syndrome (SARS) caused by COVID-19 and to characterize the spatial distribution of vaccination coverage among children and adolescents aged 0–19 years in Brazil. Methods Spatial analysis study using secondary data from the 5,570 municipalities in Brazil. Cases and deaths from SARS caused by COVID-19 among children and adolescents aged 0–19 years reported between March 2020 and December 2024 in the Influenza Epidemiological Surveillance Information System (Sistema de Informação da Vigilância Epidemiológica da Gripe, SIVEP-Gripe) were included. Vaccination records from January 2021 to December 2024 were analyzed. Vaccination coverage rates were calculated by age group and vaccination schedule. Space-time clusters were identified using the spatial scan technique. Results A total of 74,470 cases and 3,749 deaths were recorded in the population aged 0–19 years. Significant clusters of high and low risk were identified, including one protective cluster for cases among individuals aged 0–19 years (relative risk [RR] 0.28; 95% confidence interval [95%CI] 0.27; 0.29) and another high-risk cluster for deaths in the North, Northeast, and Central-West regions (RR 3.28; 95%CI 3.00; 3.59). Primary vaccination reached high coverage (85.2%), especially among adolescents aged 15–19 years (96.8%), whereas booster dose coverage remained insufficient (23.1%). The spatial distribution showed heterogeneity, with lower vaccination coverage in the North and Central-West regions. Conclusion Space-time inequalities were observed in cases and deaths from severe acute respiratory syndrome (SARS) caused by COVID-19 among children and adolescents, with risk clusters and heterogeneity in vaccination coverage, characterized by high primary coverage and low booster coverage, especially in the North and Central-West regions..
Reginaldo Bazon Vaz Tavares, Y. M. Alves, Nathália Zini et al.· Epidemiologia e Serviços de...· 0 citations
