Spatial and temporal patterns of infant mortality and its components in Rio de Janeiro / Padrões espaciais e temporais da mortalidade infantil e seus componentes no Rio de Janeiro

ABSTRACT Objectives. The study aims to assess the trend of neonatal, post-neonatal, and infant mortality from 1996 to 2020 within the metropolitan region of the state of Rio de Janeiro and other regions. Methods. Ecological study using the region as analysis unity. Data were accessed from the Mortality Information System and Live Birth Information System in the capital Rio de Janeiro, in the neighboring areas of Niterói, São Gonçalo, Baixada Fluminense, and the remaining regions of the state of Rio de Janeiro State. We applied Poisson multilevel modeling, where the models' response variables were infant mortality and its neonatal and post neonatal components. Fixed effects of the adjusted models were region and death year variables. Results. During the 1996-2020 period, the Baixada Fluminense showed the highest infant mortality rate as to its neonatal and post neonatal components. All adjusted models showed that the more recent the year the lower the mortality risk. Niterói showed the lowest adjusted risk of infant mortality and its neonatal and post neonatal components. Conclusion. Baixada Fluminense showed the highest mortality risk for infant mortality and its neonatal and post-neonatal components in the metropolitan region. The stabilization in mortality rates in recent years was identified by the research.

RESUMO Objetivos. Avaliar a tendência da mortalidade neonatal, pós-neonatal e infantil de 1996 a 2020, na região metropolitana do estado do Rio de Janeiro e nas outras regiões. Métodos. Estudo ecológico utilizando regiões como unidade de análise. Os dados foram acessados no Sistema de Informações sobre Mortalidade e Sistema de Informações sobre Nascidos Vivos da Capital (Rio de Janeiro), dos territórios vizinhos (Niterói, São Gonçalo e Baixada Fluminense) e das outras regiões do Estado do Rio de Janeiro. Utilizamos a modelagem multinível de Poisson, onde as variáveis de resposta dos modelos foram mortalidade infantil e seus componentes neonatal e pós-neonatal. Os efeitos fixos dos modelos ajustados foram região e ano da morte. Resultados. No período 1996-2020, a Baixada Fluminense apresentou a maior taxa de mortalidade infantil de seus componentes neonatal e pós-natal na região metropolitana. Todos os modelos ajustados mostraram que quanto mais recente o ano, menor o risco de mortalidade. O risco ajustado da mortalidade infantil e seus componentes neonatal e pós-neonatal foi menor em Niterói. Conclusão. A Baixada Fluminense apresentou o maior risco de mortalidade infantil e de seus componentes neonatal e pós-neonatal na região metropolitana. Detectamos estabilização das taxas de mortalidade nos últimos anos.

Characterization of COVID-19 cases in a poor community in Rio de Janeiro/Brazil focusing on the agglomeration-poverty dichotomy / Caracterização dos casos de COVID-19 em uma comunidade carente no Rio de Janeiro/Brasil com foco na dicotomia aglomeração-pobreza

Abstract This study aims to characterize the morbidity of COVID-19 in the year 2020 by identifying the most vulnerable areas and areas of clustering of cases in a favela from Rio de Janeiro/Brazil known as Manguinhos. This is a cross-sectional descriptive study performed from March 16, 2020, to August 12, 2020. We described the sociodemographic profile of the cases and performed spatial analysis using point and Kernel maps. Incidence rates were calculated by sex, age, and sub-regions. The incidence rate was 202/10,000. We detected clusters of cases west, central-north, and central-south of Manguinhos. High incidence rates were observed also in sub-regions of central-north, central-south, and southwest. In the sub-regions with high incidence, the percentage of people depending on financial governmental aid ranged between 13% and 21%. The sub-regions with the highest agglomeration of cases in the territory of Manguinhos coincide with the regions with the highest incidence rates, but not with the poorest regions of the territory.

Resumo O objetivo deste estudo é caracterizar a morbidade da COVID-19 no ano de 2020, identificando as áreas mais vulneráveis e áreas de aglomeração de casos em uma favela do Rio de Janeiro/Brasil conhecida como Manguinhos. Trata-se de um estudo descritivo transversal realizado de 16 de março a 12 de agosto de 2020. Descrevemos o perfil sociodemográfico dos casos e fizemos análise espacial por meio de mapas de pontos e Kernel. As taxas de incidência foram calculadas por sexo, idade e sub-regiões. A taxa de incidência foi de 202/10.000 habitantes. Detectamos aglomerados de casos a oeste, centro-norte e centro-sul de Manguinhos. Altas taxas de incidência foram observadas também nas sub-regiões centro-norte, centro-sul e sudoeste. Nas sub-regiões com alta incidência, o percentual de pessoas dependentes de ajuda financeira governamental variou entre 13% e 21%. As sub-regiões com maior aglomeração de casos no território de Manguinhos coincidem com as regiões com as maiores taxas de incidência, mas não com as regiões mais pobres do território.

Mortality by colon, lung, esophagus, prostate, cervix and breast cancers in Brazilian capitals, 2000-2015: a multilevel analysis.

This study aimed to analyze the role of period, geographic and socio demographic factors in cancer-related mortality by prostate, breast, cervix, colon, lung and esophagus cancer in Brazilians capitals (2000-2015). Ecological study using data of Brazilian Mortality Information. Multilevel Poisson models were used to estimate the adjusted risk of cancer mortality. Mortality rate levels were higher in males for colon, lung and esophageal cancers. Mortality rates were highest in the older. Our results showed an increased risk of colon cancer mortality in both sexes from 2000 to 2015, which was also evidenced for breast and lung cancers in women. In both genders, the highest mortality risk for lung and esophageal cancers was observed in Southern capitals. Midwestern, Southern and Southeastern capitals showed the highest mortality risk for colon cancer both for males and females. Colon cancer mortality rate increased for both genders, while breast and lung cancers mortality increased only for women. The North region showed the lowest mortality rate for breast, cervical, colon and esophageal cancers. The Midwest and Northeast regions showed the highest mortality rates for prostate cancer.

Clinical Impact of the Line Probe Assay and Xpert® MTB/RIF Assay in the Presumptive Diagnosis of Drug-Resistant Tuberculosis in Brazil: A Pragmatic Clinical Trial.

BACKGROUND: Rapid molecular methods such as the line probe assay (LPA) and Xpert® MTB/RIF assay (Xpert) have been recommended by the World Health Organization for drug-resistant tuberculosis (DR-TB) diagnosis. We conducted an interventional trial in DR-TB reference centers in Brazil to evaluate the impact of the use of LPA and Xpert. METHODS: Patients with DR-TB were eligible if their drug susceptibility testing results were available to the treating physician at the time of consultation. The standard reference MGITTM 960 was compared with Xpert (arm 1) and LPA (arm 2). Effectiveness was considered as the start of the appropriate TB regimen that matched drug susceptibility testing (DST) and the proportions of culture conversion and favorable treatment outcomes after 6 months. RESULTS: A higher rate of empirical treatment was observed with MGIT alone than with the Xpert assay (97.0% vs. 45.0%) and LPA (98.2% vs. 67.5%). Patients started appropriate TB treatment more quickly than those in the MGIT group (median 15.0 vs. 40.5 days; p<0.01) in arm 1. Compared to the MGIT group, culture conversion after 6 months was higher for Xpert in arm 1 (90.9% vs. 79.3%, p=0.39) and LPA in arm 2 (80.0% vs. 83.0%, p=0.81). CONCLUSIONS: In the Xpert arm, there was a significant reduction in days to the start of appropriate anti-TB treatment and a trend towards greater culture conversion in the sixth month.

Mortality by colon, lung, esophagus, prostate, cervix and breast cancers in Brazilian capitals, 2000-2015: a multilevel analysis / Mortalidade por câncer de cólon, pulmão, esôfago, próstata, colo do útero e mama nas capitais brasileiras, 2000-2015: uma análise multinível

Abstract This study aimed to analyze the role of period, geographic and socio demographic factors in cancer-related mortality by prostate, breast, cervix, colon, lung and esophagus cancer in Brazilians capitals (2000-2015). Ecological study using data of Brazilian Mortality Information. Multilevel Poisson models were used to estimate the adjusted risk of cancer mortality. Mortality rate levels were higher in males for colon, lung and esophageal cancers. Mortality rates were highest in the older. Our results showed an increased risk of colon cancer mortality in both sexes from 2000 to 2015, which was also evidenced for breast and lung cancers in women. In both genders, the highest mortality risk for lung and esophageal cancers was observed in Southern capitals. Midwestern, Southern and Southeastern capitals showed the highest mortality risk for colon cancer both for males and females. Colon cancer mortality rate increased for both genders, while breast and lung cancers mortality increased only for women. The North region showed the lowest mortality rate for breast, cervical, colon and esophageal cancers. The Midwest and Northeast regions showed the highest mortality rates for prostate cancer.

Resumo Este estudo teve como objetivo analisar o papel de fatores temporais, geográficos e sociodemográficos na mortalidade por câncer de próstata, mama, colo do útero, cólon, pulmão e esôfago nas capitais brasileiras (2000-2015). Estudo ecológico utilizando informações brasileiras de mortalidade. Modelos de Poisson multinível foram usados ​​para estimar o risco ajustado de mortalidade por câncer. Os níveis de mortalidade foram maiores em homens para câncer de cólon, pulmão e esôfago. As taxas de mortalidade foram mais altas nos idosos. Nossos resultados mostraram risco aumentado de mortalidade por câncer de cólon em ambos os sexos de 2000 a 2015, o que também foi evidenciado para câncer de mama e de pulmão em mulheres. Em ambos os sexos, o maior risco de mortalidade para câncer de pulmão e esôfago foi observado nas capitais do Sul. As capitais do Centro-Oeste, Sul e Sudeste apresentaram o maior risco de mortalidade por câncer de cólon tanto para homens quanto para mulheres. A taxa de mortalidade por câncer de cólon aumentou para ambos os sexos, enquanto a mortalidade por câncer de mama e de pulmão aumentou apenas para as mulheres. A região Norte apresentou a menor taxa de mortalidade por câncer de mama, colo do útero, cólon e esôfago. As regiões Centro-Oeste e Nordeste apresentaram as maiores taxas de mortalidade por câncer de próstata.

Analysis of the Main Groups Victimized by Familiar Violence and by Violence by a Known Person in Brazil.

ABSTRACT: This study aims to evaluate the ratio of the number of cases of family violence and violence by a known person, over the four surveys that took place in 2006, 2007, 2009, and 2011, within the population treated in the Brazilian health services, according to demographic and socioeconomic characteristics. Data from the Vigilância de Violências e Acidentes survey was used. The variables age, victim sex, aggressor sex, race, and schooling level were considered in the analysis. This study pointed out decreasing trend in the number of violence-related care within the older age group. The number of familial violence-related care per victim sex was higher for male victims when the aggressor was female, and conversely, it was higher for female victims when the aggressor was male. The number of violence-related care was mostly higher in non-White people than in White. People with low schooling levels showed the highest ratio of the number of violence-related care.

Clinical Impact of the Line Probe Assay and Xpert® MTB/RIF Assay in the Presumptive Diagnosis of Drug-Resistant Tuberculosis in Brazil: A Pragmatic Clinical Trial

ABSTRACT Background: Rapid molecular methods such as the line probe assay (LPA) and Xpert® MTB/RIF assay (Xpert) have been recommended by the World Health Organization for drug-resistant tuberculosis (DR-TB) diagnosis. We conducted an interventional trial in DR-TB reference centers in Brazil to evaluate the impact of the use of LPA and Xpert. Methods: Patients with DR-TB were eligible if their drug susceptibility testing results were available to the treating physician at the time of consultation. The standard reference MGITTM 960 was compared with Xpert (arm 1) and LPA (arm 2). Effectiveness was considered as the start of the appropriate TB regimen that matched drug susceptibility testing (DST) and the proportions of culture conversion and favorable treatment outcomes after 6 months. Results: A higher rate of empirical treatment was observed with MGIT alone than with the Xpert assay (97.0% vs. 45.0%) and LPA (98.2% vs. 67.5%). Patients started appropriate TB treatment more quickly than those in the MGIT group (median 15.0 vs. 40.5 days; p<0.01) in arm 1. Compared to the MGIT group, culture conversion after 6 months was higher for Xpert in arm 1 (90.9% vs. 79.3%, p=0.39) and LPA in arm 2 (80.0% vs. 83.0%, p=0.81). Conclusions: In the Xpert arm, there was a significant reduction in days to the start of appropriate anti-TB treatment and a trend towards greater culture conversion in the sixth month.

Association between visual problems, insufficient emotional support and urinary incontinence with disability in elderly people living in a poor district in Rio de Janeiro, Brazil: A six-year follow-up study.

INTRODUCTION: Disability follows the rapid rate of population ageing, imposing a huge burden on society. Functional assessment in older people can identify predictors of disability. OBJECTIVE: Analyze the incidence and the risk factors for disability in activities of daily living (ADL) and instrumental activities of daily living (IADL) in older adults over six years. METHODS: Six year-follow up study initiated in 2010. The baseline non-probabilistic sample consisted of 180 independent community dwelling individuals aged 60 and over. The procedures comprised an interview with sociodemographic data, questions about falls, urinary incontinence, self-rated health, and assessment of ADL, IADL, mobility, depression, vision, hearing, cognition, nutrition, grip strength and social support. The second research was carried out by telephone and assessed ADL and IADL. Logistic regression models calculated the odds of disability in ADL and IADL according to the age, sex and all other variables. RESULTS: At six-year follow-up, 118 participants were still alive (65.6%), 31 died (17%) and other 31 were missed (17%). The incidence of disability to performADL and IADL were 25.4% and 32.3%, respectively. The regression logistic models revealed thaturinary incontinence (OR = 3.2; P = 0.03) and insufficient emotional support (OR = 3.8; P = 0.04) were associated with ADL disability, while visual problems (OR: 2.9; P = 0.03) and insufficient emotional support (OR: 5.6; P = 0.01) were associated with IADL disability. CONCLUSION: The current study has identified that insufficient emotional support, visual problems and urinary incontinence are associated with disability in older adults. The routine assessment of these problems in the primary care clinics enable the implementation of strategies aimed at reducing or postponing disability. Educating patients and families will also enable better choices to reduce the risk of functional decline.

Risk factors for the ill-defined causes of death in the Brazilian states: a multilevel analysis.

This study describes the spatial-temporal changes of the proportion of ill-defined causes of death in Brazil (1998-2012) and investigates which demographic and socioeconomic factors affect this proportion. We collected information of the proportion of ill-defined causes of death by age (15-59 years), sex, period, locality, and socioeconomic data. We used a multilevel Poisson model to investigate which factors affect the risk of ill-defined causes of death. Unlike states located in the South and Midwest, we detected clusters with high proportional levels of these deaths in states in the North and Northeast regions. A greater proportion occurred in 1998-2002 (0.09), in the North and Northeast (0.14 and 0.12, respectively), in older age groups (0.09), and in places with poor socioeconomic conditions. The adjusted analysis showed differences in proportion according to the region, age, period, schooling, social inequality, and income. The results indicate that the lower the age group and the better the socioeconomic situation, the lower the risk to register the cause of death as ill-defined. Although over the past years, the quality of Brazil's mortality data has gradually increased, investments towards improving mortality registries cannot be discontinued.

Diagnóstico da tuberculose

Este recurso educacional visa promover a compreensão sobre o diagnóstico da tuberculose por meio de avaliação clínica e de exames complementares, como a baciloscopia, o Teste rápido molecular para tuberculose (TRM-TB), teste de sensibilidade, exames de cultura e radiológicos. Além deste, há mais de 30 e-books tratando sobre diversas questões relacionadas à Vigilância em Saúde. Todos eles fornecem conteúdos interessantes para a formação dos profissionais que atuam no SUS, especialmente os vinculados à Vigilância em Saúde, e acadêmicos da área da saúde. Compõe o conjunto de cursos sobre Vigilância em Saúde ofertados pela UNA-SUS/UFMA.

Exames complementares para diagnóstico da tuberculose

Este recurso educacional visa fazer com que os leitores conheçam e compreendam os exames complementares e métodos para diagnóstico de Mycobacterium tuberculosis. Alguns dos métodos apresentados são: o exame histopatológico, escore clínico-epidemiológico, testagem para o vírus HIV, exames de contatos, exames complementares e o diagnóstico da infecção latente tuberculosa (ILTB). Além deste, há mais de 30 e-books tratando sobre diversas questões relacionadas à Vigilância em Saúde. Todos eles fornecem conteúdos interessantes para a formação dos profissionais que atuam no SUS, especialmente os vinculados à Vigilância em Saúde, e acadêmicos da área da saúde. Compõe o conjunto de cursos sobre Vigilância em Saúde ofertados pela UNA-SUS/UFMA.

Controle da tuberculose: busca ativa de sintomáticos respiratórios

Este recurso educacional visa promover a compreensão sobre a busca de sintomáticos respiratórios nos casos de tuberculose. Apresenta as técnicas de coleta como a do escarro espontâneo e escarro induzido. Aborda a importância dos dados de registro de sintomáticos respiratórios e outras estratégias operacionais. Além deste, há mais de 30 e-books tratando sobre diversas questões relacionadas à Vigilância em Saúde. Todos eles fornecem conteúdos interessantes para a formação dos profissionais que atuam no SUS, especialmente os vinculados à Vigilância em Saúde, e acadêmicos da área da saúde. Compõe o conjunto de cursos sobre Vigilância em Saúde ofertados pela UNA-SUS/UFMA.

Tratamento da tuberculose

Este recurso educacional visa promover a compreensão sobre o tratamento da tuberculose, considerando todos os fatores envolvidos neste processo. Apresenta os princípios do tratamento para a TB e uma linha do tempo evolutiva dos medicamentos para o tratamento da doença desde 1944. Além deste, há mais de 30 e-books tratando sobre diversas questões relacionadas à Vigilância em Saúde. Todos eles fornecem conteúdos interessantes para a formação dos profissionais que atuam no SUS, especialmente os vinculados à Vigilância em Saúde, e acadêmicos da área da saúde. Compõe o conjunto de cursos sobre Vigilância em Saúde ofertados pela UNA-SUS/UFMA.

Acompanhamento, imunização e quimioprofilaxia da tuberculose

Este recurso educacional visa promover a compreensão sobre as características do tratamento diretamente observado e as ações para aderi-lo, a importância do sistema de informação para o monitoramento da doença em território brasileiro e os esquemas de vacinação e estratégias preventivas existentes contra a tuberculose. Além deste, há mais de 30 e-books tratando sobre diversas questões relacionadas à Vigilância em Saúde. Todos eles fornecem conteúdos interessantes para a formação dos profissionais que atuam no SUS, especialmente os vinculados à Vigilância em Saúde, e acadêmicos da área da saúde. Compõe o conjunto de cursos sobre Vigilância em Saúde ofertados pela UNA-SUS/UFMA.

Vigilância, prevenção e eliminação da tuberculose como problema de Saúde Pública

Este recurso educacional integra o conjunto de objetos na área temática de Vigilância em Saúde, ofertados pela UNA-SUS/UFMA. Trata-se de um curso autoinstrucional, com carga horária sugerida de 30 horas. O curso é composto por 3 unidades educacionais e tem como objetivo compreender as ações de vigilância, prevenção, diagnóstico e manejo de casos clínicos da tuberculose, com vistas à eliminação da doença como um problema de saúde pública no Brasil. São abordados assuntos como: fisiopatogenia, transmissão, determinantes sociais e populações com maior vulnerabilidade, além da rede de atenção e o papel da Atenção Básica na eliminação da doença; diagnóstico, exames complementares e busca ativa de sintomáticos respiratórios; tratamento e monitoramento da doença.

Risk factors for the ill-defined causes of death in the Brazilian states: a multilevel analysis / Fatores de risco associados aos óbitos por causas mal definidas nos estados do Brasil: uma análise multinível

Abstract This study describes the spatial-temporal changes of the proportion of ill-defined causes of death in Brazil (1998-2012) and investigates which demographic and socioeconomic factors affect this proportion. We collected information of the proportion of ill-defined causes of death by age (15-59 years), sex, period, locality, and socioeconomic data. We used a multilevel Poisson model to investigate which factors affect the risk of ill-defined causes of death. Unlike states located in the South and Midwest, we detected clusters with high proportional levels of these deaths in states in the North and Northeast regions. A greater proportion occurred in 1998-2002 (0.09), in the North and Northeast (0.14 and 0.12, respectively), in older age groups (0.09), and in places with poor socioeconomic conditions. The adjusted analysis showed differences in proportion according to the region, age, period, schooling, social inequality, and income. The results indicate that the lower the age group and the better the socioeconomic situation, the lower the risk to register the cause of death as ill-defined. Although over the past years, the quality of Brazil's mortality data has gradually increased, investments towards improving mortality registries cannot be discontinued.

Resumo Este estudo descreve as mudanças espaço-temporais da proporção de causas mal definidas no Brasil (1998-2012) e seus fatores associados. Coletamos informações da proporção de óbitos por causas mal definidas por idade (15-59 anos), sexo, período, local de residência, além de fatores socioeconômicos. Utilizou-se modelo multinível de Poisson para investigar os fatores associados às causas mal definidas dos óbitos. Ao contrário dos estados do sul e centro-oeste, identificou-se clusters com elevados níveis proporcionais destes óbitos nos estados do norte, nordeste e sudeste. A maior proporção de óbitos mal definidos ocorreu em 1998-2002 (0,09), no norte e nordeste (0,14 e 0,12, respectivamente), nos grupos etários mais velhos (0,09) e nos locais com condições socioeconômicas desfavoráveis. A análise ajustada indicou diferença dos níveis de causas mal definidas de acordo com a região, a idade, o período, a escolaridade, a desigualdade social e a renda. Nossos resultados sugerem que quanto menor a faixa etária e melhores as condições socioeconômicas, menor o risco de óbitos mal definidos. Apesar de nos últimos anos a qualidade dos dados de mortalidade no Brasil ter aumentado, os investimentos na melhoria do registro dos óbitos não podem ser descontinuadas.

Distribution of pulmonary tuberculosis in Rio de Janeiro (Brazil): a spatial analysis.

The aim of this study was to analyze the spatial distribution of the tuberculosis endemic in Rio de Janeiro State from 2002 to 2011. A retrospective study was conducted in the state of Rio de Janeiro from 2002 to 2011. Spatial analysis techniques were used to describe the distribution of tuberculosis incidence in the state. Multilevel Poisson regression model was used to access the relationship of tuberculosis and the following factors: "sex", "age-group" and "diagnostic year" (individual-level factors). Demographic density and municipality were also included in the model as contextual-level factors. A reduction in endemic tuberculosis was observed over the years. The highest incidence rates were concentrated on the south coast of the state, covering Rio de Janeiro City (capital) and neighboring cities. We detected a significant clustering of high TB incidence rates on the south coast of the state and a cluster of low incidence in the northeastern region of state. The risk of tuberculosis was higher in early 2000s, in males and in 40-59 age group. Metropolitan regions are important risk areas for the spread of tuberculosis. These findings could be used to plan control measures according to the characteristics of each region.

Distribution of pulmonary tuberculosis in Rio de Janeiro (Brazil): a spatial analysis / Distribuição da tuberculose pulmonar no Rio de Janeiro (Brasil): uma análise espacial

Abstract The aim of this study was to analyze the spatial distribution of the tuberculosis endemic in Rio de Janeiro State from 2002 to 2011. A retrospective study was conducted in the state of Rio de Janeiro from 2002 to 2011. Spatial analysis techniques were used to describe the distribution of tuberculosis incidence in the state. Multilevel Poisson regression model was used to access the relationship of tuberculosis and the following factors: "sex", "age-group" and "diagnostic year" (individual-level factors). Demographic density and municipality were also included in the model as contextual-level factors. A reduction in endemic tuberculosis was observed over the years. The highest incidence rates were concentrated on the south coast of the state, covering Rio de Janeiro City (capital) and neighboring cities. We detected a significant clustering of high TB incidence rates on the south coast of the state and a cluster of low incidence in the northeastern region of state. The risk of tuberculosis was higher in early 2000s, in males and in 40-59 age group. Metropolitan regions are important risk areas for the spread of tuberculosis. These findings could be used to plan control measures according to the characteristics of each region.

Resumo O objetivo deste estudo foi analisar a distribuição espacial da tuberculose (TB) endêmica no Rio de Janeiro 2002-2011. Estudo retrospectivo realizado no Estado do Rio de Janeiro, 2002-2011. Técnicas de análise espacial foram utilizadas para descrever a distribuição de incidência de tuberculose no estado. Modelo de regressão multinível de Poisson foi utilizado para acessar a relação de tuberculose e os fatores: "sexo", "faixa etária" e "ano de diagnóstico" (fatores de nível individual). A "Densidade demográfica" e o "município de residência" também foram incluídos no modelo como fatores de nível contextual. Houve redução da tuberculose endêmica ao longo dos anos. As maiores taxas de incidência se concentraram no litoral sul do estado, abrangendo capital e cidades vizinhas. Observamos a formação de cluster significativo com altas taxas de incidência de TB no litoral sul do estado e cluster de baixa incidência na região nordeste do estado. O risco de tuberculose foi maior no início de 2000, no sexo masculino e na faixa etária 40-59. As megacidades são áreas de risco importantes para a disseminação da tuberculose. Estes achados poderiam ser usados para planejar medidas de controle de acordo com as características de cada região.