Panorama da tuberculose na Região Norte do Brasil: Análise epidemiológica de 2020 a 2024
Abstract
ntroduction
Tuberculosis is an infectious and contagious disease caused by the bacterium Mycobacterium tuberculosis, also known as Koch's bacillus. Although the lung is the most affected organ (pulmonary form), the infection can also compromise other organs and systems, characterizing the so-called extrapulmonary form. Despite being an ancient disease, tuberculosis still represents one of the greatest public health challenges. It is estimated that, annually, approximately 10 million people fall ill worldwide, resulting in more than one million deaths. In Brazil, more than 84,000 new cases are reported each year, with about 6,000 annual deaths recorded (Brasil, 2023).
Transmission occurs mainly through the airborne route, by inhaling aerosols expelled during coughing, speaking, or sneezing by individuals with the active form of the disease who are not undergoing treatment. When inhaled by other people, these particles can result in infection. It is estimated that an individual with active tuberculosis, without therapeutic follow-up and releasing bacilli into the environment, can infect an average of 10 to 15 people in their community over the course of a year (Brasil, 2023).
In Brazil, the diagnosis of tuberculosis follows official protocols and involves both clinical evaluation and laboratory tests, supplemented by a chest X-ray. The treatment lasts a minimum of six months, is free, and is offered exclusively by the SUS (Unified Health System). When followed correctly until the end, a cure is guaranteed. Close monitoring by health professionals, with a comprehensive and humanized approach, is essential for treatment adherence. With the start of treatment, transmissibility progressively decreases, and generally, after 15 days, the risk of transmission is already significantly reduced (Brasil, 2023).
The main preventive measure against tuberculosis is the BCG vaccine, available in the SUS, administered at birth or up to 4 years of age. It protects against the most severe forms of the disease, such as miliary and meningeal tuberculosis. In addition to immunization, it is crucial to adopt measures that reduce transmission, such as keeping environments ventilated and exposed to sunlight, practicing respiratory hygiene when coughing or sneezing, and avoiding crowded places (Brasil, 2023).
The risk of developing tuberculosis is associated not only with exposure to the bacillus and the immune system but also with socioeconomic factors. Some groups are more vulnerable compared to the general population, such as people in street situations (54 times), the incarcerated population (26 times), indigenous people (1.7 times), immigrants (5.8 times), people living with HIV/AIDS (23 times), and health professionals (4 times). In addition to these, communities such as riverine populations (ribeirinhos), quilombolas, gypsies, fishermen, populations from Afro-Brazilian religious centers (terreiros), and rural populations may also face conditions that increase the risk of illness and hinder access to healthcare (Brasil, 2024).
In the North Region, factors such as territorial extension, low population density in some areas, transportation difficulties, and limited access to health services potentiate the vulnerability of communities to tuberculosis. The socioeconomic and geographical characteristics of the region, combined with the presence of traditional and riverine populations, influence not only the occurrence of the disease but also the early detection and proper follow-up of cases. Therefore, aiming to understand the epidemiological panorama of tuberculosis in the North Region is fundamental to guiding effective public health policies tailored to the specific needs of this territory (Brasil, 2024).
Methodology
2.1 Study Type This is a quantitative, descriptive, and epidemiological study, focusing on the analysis of tuberculosis occurrence in the states of the North Region of Brazil. This approach allows for an understanding of the disease's behavior over a broader time interval, providing a basis for regional comparisons and discussions on epidemiological trends.
2.2 Study Location and Period The period selected for the investigation was from 2020 to 2024, covering five consecutive years of records. The study focused on the seven states that make up the North Region of Brazil, allowing for a detailed analysis of the distribution of tuberculosis in this territory.
2.3 Population and Sample All notified cases of tuberculosis recorded in the Notifiable Diseases Information System (SINAN) during the defined period were considered. The reference population corresponds to the inhabitants of the states in the North Region, according to official estimates.
2.4 Data Collection Instruments The data used were extracted from SINAN, made available by the Secretariat of Health and Environment Surveillance of the Ministry of Health. The records were consolidated by state and year, ensuring the reliability of the information used to calculate the epidemiological indicators.
2.5 Data Collection Procedures To calculate the standardized rate, the number of cases registered between 2020 and 2024 in each state was summed. Then, the total value was divided by the estimated population of the respective state and multiplied by 100,000 inhabitants. This procedure provided an average estimate of the cumulative incidence of tuberculosis in the study period, enabling comparison among the states of the region, regardless of their absolute population differences.
2.6 Data Treatment and Analysis The data analysis was conducted descriptively, using frequency measures to characterize the tuberculosis cases. The calculated rates allowed for identifying the distribution of the disease among the different states of the North Region, enabling the visualization of epidemiological patterns and the identification of priority areas for tuberculosis control. This approach also facilitated the interpretation of the results in light of regional inequalities and structural factors that influence the disease's occurrence.
2.7 Ethical Aspects The study opted for the use of secondary data from public access, which exempts it from approval by a Research Ethics Committee, according to Resolution No. 510/2016 of the National Health Council, which regulates studies based on public domain information. Nevertheless, all stages of the work followed criteria of scientific rigor, respecting the confidentiality of the notified individuals, as the data were analyzed in an aggregated and personally unidentified manner.
Results
The data analyzed for the period from 2020 to 2024 show marked differences in the incidence of tuberculosis among the states of the North Region. When adjusted per 100,000 inhabitants, it is observed that Amazonas had the highest rate, with 524 cases, followed by Acre (355), Pará (333), and Roraima (325). Amapá (294) and Rondônia (220) were at intermediate levels, while Tocantins had the lowest value (77), standing out as the state with the lowest relative burden of the disease in the region.
This distribution reveals that, although all states in the North Region register significant cases, there are disparities that reflect not only population size but also social, economic, and structural factors related to access to health services, living conditions, and diagnostic capacity. Amazonas, with the highest rate, reinforces the importance of considering aspects such as population density, social vulnerability, and geographical limitations to understand the persistence of the high burden of tuberculosis. On the other hand, Tocantins, with a lower rate, may reflect either a different epidemiological reality or possible limitations in case detection and notification, which deserves attention in the planning of control actions.
The results found show a heterogeneity in the distribution of tuberculosis among the states of the North Region, with rates ranging from 77 cases per 100,000 inhabitants in Tocantins to 524 in Amazonas. This scenario confirms that tuberculosis remains a serious public health problem in the region, but with significant internal disparities. According to Rodrigues et al. (2021), such differences are directly associated with the living conditions of the population, including factors such as precarious housing, low income, difficulties in accessing health services, and social inequality, all widely present in various Amazonian territories.
In the case of Acre, which had a high rate (355/100,000), studies indicate that the maintenance of high incidence rates is related to social vulnerability, the concentration of cases in poorer urban areas, and the logistical difficulties of care in the Amazon region (Santos et al., 2022). This reality is also observed in other states of the North, reinforcing that the socioeconomic and territorial context has a great influence on the illness.
Amazonas has not only the highest incidence of tuberculosis in the North Region but also the highest mortality rate in the country, with 5.1 deaths per 100,000 inhabitants in 2022, almost double the national average of 2.72/100,000. This scenario shows that the impact of the disease in the state goes beyond the emergence of new cases, resulting in a significant number of deaths. Part of this reality can be explained by the difficulties faced during the COVID-19 pandemic, which interrupted several control actions, and by the precarious socioeconomic conditions of the region, such as inadequate housing, poor ventilation, and difficulty in accessing health services. The combination of high incidence and mortality demonstrates the urgent need to strengthen strategies for early diagnosis, treatment adherence, and continuous follow-up, while also investing in prevention measures and social improvements capable of reducing the population's vulnerability to tuberculosis (REDE-TB, 2024).
Furthermore, the analysis of tuberculosis at the national level shows that Brazil has multiple epidemiological realities, with states and regions in very different situations. The North Region has historically recorded rates above the national average, which reflects structural inequalities in the health system and social development, making disease control even more challenging. This heterogeneity suggests that uniform public policies are not sufficient, and it is necessary to consider local specificities in the planning of surveillance and prevention actions (Cortez et al., 2024).
Another important point is that time-series studies show that, despite advances in diagnosis and treatment, the incidence of tuberculosis in Brazil tends to remain high until 2030, especially in areas of greater vulnerability (Oliveira et al., 2022). This indicates that the findings of this study, by showing high rates in the states of the North Region, align with national projections and reinforce the urgency of more effective measures for the country to achieve the goals proposed by the Sustainable Development Goals (SDGs).
Conclusion
The analysis of tuberculosis in the North Region between 2020 and 2024 revealed high incidence rates, especially in Amazonas, which not only concentrates the largest number of proportional cases but also has the highest tuberculosis mortality rate in the country. These findings reinforce that the disease remains a public health challenge of great magnitude, impacted by structural factors such as social inequality, difficulties in accessing diagnosis and treatment, and geographical barriers typical of the Amazon (Pessoa and Gomez, 2023).
In the national scenario, the elimination of tuberculosis still faces significant obstacles, as highlighted by Silva et al. (2021), the main ones being insufficiency in early detection, gaps in the coverage of surveillance actions, and the persistence of social determinants that perpetuate population vulnerability. Furthermore, treatment abandonment, widely reported in different studies, directly compromises disease control, favoring continuous transmission and the emergence of resistant forms of the bacillus. This reveals that tackling tuberculosis requires more than effective clinical protocols: it requires consistent, integrated public policies geared to local realities (Barreira, 2018; Ferreira et al., 2018).
Given this panorama, it is essential that specific strategies be strengthened in the North Region, including the expansion of diagnostic coverage, the guarantee of treatment adherence, and an intersectoral approach that considers the social determinants of illness. Only with the integration of health, social assistance, and education, combined with the strengthening of surveillance and primary care networks, will it be possible to advance in reducing the burden of tuberculosis and bring Brazil closer to the goals proposed, for example, by the Sustainable Development Goals.
