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Socioeconomic dynamics and tuberculosis mortality in São Paulo: a population-level analysis using spatial modeling
Yan Mathias Alves1, Reginaldo Bazon Vaz Tavares1, Nathalia Zini1
1Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Brazil.
Lancet Regional Health. Americas
|July 28, 2026
Summary
Tuberculosis mortality in São Paulo is linked to household crowding and an aging population, while increased primary health care coverage reduces deaths. Spatial analysis reveals regional disparities in mortality rates.
Area of Science:
- Public Health
- Epidemiology
- Spatial Analysis
Background:
- Tuberculosis (TB) is a leading cause of preventable death in Brazil, exacerbated by socioeconomic and territorial disparities.
- Limited evidence exists on the association between socioeconomic factors, health systems, and TB mortality across different age groups in high-burden areas like São Paulo state.
- This study investigates spatial and temporal patterns of TB mortality in São Paulo municipalities.
Purpose of the Study:
- To examine the spatial and temporal associations between socioeconomic conditions, health system characteristics, and tuberculosis mortality.
- To identify key factors contributing to TB mortality across different age groups in São Paulo state.
- To inform targeted public health interventions for TB control.
Main Methods:
- Population-based ecological study utilizing data from the Mortality Information System (2020-2024).
- Socioeconomic, demographic, and health system factors were analyzed using Generalized Additive Models for Location, Scale, and Shape (GAMLSS) with spatial smoothing.
- Inclusion of 38,700 municipality-month observations for comprehensive analysis.
Main Results:
- Household crowding and a higher proportion of elderly individuals (>59 years) were significantly associated with increased TB mortality.
- Increased primary health care coverage showed a significant association with decreased TB mortality.
- Spatial analysis revealed higher TB mortality in coastal and central regions, and lower rates in the northwestern region of São Paulo.
Conclusions:
- Tuberculosis mortality in São Paulo is influenced by socioeconomic and territorial inequalities, with varying patterns across age groups.
- Addressing structural vulnerabilities and strengthening primary health care are crucial for reducing preventable TB deaths.
- The findings underscore the need for geographically tailored strategies to combat TB effectively.
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