Análise espacial da tuberculose pulmonar na população negra no estado do Maranhão de 2010 a 2024

Abstract

Tuberculosis, caused by Mycobacterium tuberculosis, remains one of the leading public health problems in Brazil and worldwide, accounting for high rates of morbidity and mortality. The pulmonary form is the most prevalent and epidemiologically relevant, as it represents the main route of transmission and accounts for most hospital admissions. This study aimed to analyze the spatial distribution of hospitalizations due to pulmonary tuberculosis among the Black population in the state of Maranhão, Brazil, from 2010 to 2024. This is a retrospective ecological study based on data from the Brazilian Unified Health System Hospital Information System and population projections from the Brazilian Institute of Geography and Statistics. Hospitalization rates per 100,000 Black inhabitants were calculated and represented in thematic maps using QGIS (version 3.28.13)® and R (version 4.2.2)® software, applying Kernel density estimation and the Local Moran’s I (LISA) technique. A total of 960 hospitalizations for pulmonary tuberculosis were recorded among individuals self-identified as Black or Brown, of whom 68.0% were male and 53.4% were aged 30–59 years. Most cases occurred in inland municipalities (76.1%). Emergency admissions predominated (69.6%), and 96% of records referred to individuals identified as Brown. Spatial analysis revealed a heterogeneous and non-random pattern, with clusters of higher concentration in the central-northern and central-southern regions of the state. LISA identified statistically significant clusters (p < 0.05), with a High–High pattern in Fernando Falcão, Fortaleza dos Nogueiras, and Grajaú, and a Low–High pattern in Formosa da Serra Negra, São Raimundo das Mangabeiras, Colinas, Tuntum, São Luís Gonzaga do Maranhão, and Poção de Pedras. In conclusion, hospitalizations for pulmonary tuberculosis among the Black population in Maranhão show an unequal spatial distribution, reflecting the influence of racial and territorial factors on the occurrence and concentration of the disease in the state.