Distribuição espacial e tendência temporal da tuberculose em pessoas privadas de liberdade no Brasil

Abstract

Introduction: tuberculosis (TB) is a major public health problem, especially in vulnerable populations. The prison environment, characterized by overcrowding, inadequate ventilation, high turnover, and limited access to health services, enhances disease transmission and challenges its control. In Brazil, the growth of the inmate population in recent decades has been accompanied by an increase in the TB burden within this group, reinforcing the need for analyses that integrate epidemiological, temporal, and spatial aspects. Objective: to analyze the epidemiological, temporal, and spatial patterns of TB among persons deprived of liberty (PDL) in Brazil from 2014 to 2024. Methods: population-based ecological study with temporal and spatial components, using secondary data from the Notifiable Diseases Information System and the National Penitentiary Information System, aggregated by Federative Unit. All new cases of TB reported between 2014 and 2024 were included. Incidence rates were calculated based on the estimated prison population. Temporal trends were analyzed using segmented regression (Joinpoint), estimating the Annual Percent Change (APC) and the Average Annual Percent Change (AAPC), with their respective 95% confidence intervals. Spatial distribution was assessed through choropleth maps of the mean incidence by Federative Unit. Sociodemographic, clinical, and diagnostic characteristics, comorbidities, associated conditions, and treatment outcomes were also analyzed. Results: a total of 821,172 new cases of TB were analyzed in Brazil, of which 78,034 occurred among PDL. There was a predominance of male individuals (97.03%), aged between 20 and 49 years (94.86%), non-white (63.10%), and with low educational level. The pulmonary clinical form was predominant (95.34%). Laboratory confirmation was high (81.78%), although gaps were identified in testing, such as culture and molecular rapid test, which was not performed in 46.08% of cases. Incidence showed an increasing trend during the analyzed period (AAPC: 4.79%; 95%CI: 0.21–9.58), with an inflection point in 2017, followed by stabilization. The highest incidence rates and growth trends were observed in the North and Northeast regions. Spatial distribution revealed a concentration of high rates in states such as Rio Grande do Norte, Pará, Sergipe, and Rio de Janeiro. Regarding outcomes, a higher proportion of cure was observed among PPL (73.69%) compared to the nondeprived population (68.45%). Conclusion: TB among PDL shows high magnitude, an increasing trend, and significant territorial inequality in Brazil. These findings highlight the need to strengthen epidemiological surveillance actions, expand early diagnosis, improve the quality of care, and implement intersectoral public policies aimed at reducing structural vulnerabilities in the prison system.