Silva Alene Bezerra Araújo, Souza Wayner Vieira de, Júnior José Constantino Silveira, Santana Juliana Silva de, Ximenes Ricardo Arraes de Alencar
Graduate Program in Health Sciences, Faculty of Medical Sciences, University of Pernambuco, Recife CEP 50100-010, PE, Brazil.
Department of Public Health, Aggeu Magalhães Research Center, Fiocruz, Recife CEP 50.740-465, PE, Brazil.
Int J Environ Res Public Health. 2025 Apr 2;22(4):545. doi: 10.3390/ijerph22040545.
Tuberculosis (TB) remains a public health problem, which the COVID-19 pandemic may have exacerbated. Scaling TB, COVID-19, and coinfection in area and socioeconomic contexts is an important way to detect more vulnerable groups.
To verify, through the spatial distribution of cases of tuberculosis, COVID-19, and coinfection, the existence of an association between the risk of illness and income.
An analytical ecological study was carried out in Recife, whose unit of analysis was the neighborhood, in the year 2020. The data were collected from the SINAN-TB, NOTIFICA-PE, and IBGE Information Systems. Neighborhoods were grouped into strata according to income through K-means analysis. Incidence rates were calculated. Marshall's Local Empirical Bayesian Smoothing Method was used. Risk ratios were calculated to estimate the magnitude of association between income strata and incidence rates.
A heterogeneous pattern of spatial distribution was verified for the three events addressed, compatible with the inequality of income distribution existing in Recife. For COVID-19, the highest incidence rates occurred in the strata of better-income neighborhoods. There was an association with a gradual increase in the incidence rate as income decreased for tuberculosis. Coinfection did not show a gradual increase in the incidence rate as income decreased, but a lower incidence rate was observed in the stratum of better economic conditions.
Studies must be carried out to verify the spatial distribution of COVID-19 and its possible association with socioeconomic factors in subsequent years. There was a positive association between low income and the risk of becoming ill from tuberculosis. The lower incidence rate of coinfection in the stratum of the higher-income population suggests that the pre-existence of TB contributes to illness by COVID-19 in the low-income population.
结核病（TB）仍然是一个公共卫生问题，新冠疫情可能使其恶化。在地区和社会经济背景下分析结核病、新冠病毒感染及合并感染情况，是发现更多弱势群体的重要途径。
通过结核病、新冠病毒感染及合并感染病例的空间分布，验证疾病风险与收入之间是否存在关联。
2020年在累西腓进行了一项分析性生态研究，分析单位为社区。数据从全国结核病信息系统（SINAN-TB）、累西腓州疾病通报系统（NOTIFICA-PE）和巴西地理统计局（IBGE）信息系统收集。通过K均值分析，根据收入将社区划分为不同层次。计算发病率。采用马歇尔局部经验贝叶斯平滑法。计算风险比以估计收入层次与发病率之间关联的程度。
对于所研究的三个事件，均验证了空间分布的异质性模式，这与累西腓存在的收入分配不平等情况相符。对于新冠病毒感染，最高发病率出现在高收入社区层次。结核病的发病率随着收入降低呈逐渐上升趋势。合并感染的发病率并未随着收入降低呈逐渐上升趋势，但在经济条件较好的层次中发病率较低。
必须开展研究以验证后续年份新冠病毒感染的空间分布及其与社会经济因素的可能关联。低收入与结核病患病风险之间存在正相关。高收入人群中合并感染发病率较低表明，结核病的预先存在会导致低收入人群感染新冠病毒后患病。
