Geographic concentration and persistence of tuberculosis burden and outcomes

In adult tuberculosis notifications in Sao Paulo state, Brazil (2013–24), hotspots covering 20% of the population accounted for 45% of notifications, 39% of deaths, and 25% of LTFU events.

• Why it matters: Under limited health budgets, control efforts need to pinpoint where incidence and poor outcomes cluster, and whether those patterns persist and differ by outcome type.
• What they did: The study geocoded 192,161 adult TB episodes into regions of ~5,000 adults with similar household incomes, used denoised Lorenz curves and Gini coefficients, and evaluated overlap, deprivation gradients, stability, and later notifications.
• The result: Notification and mortality hotspots overlapped substantially (Jaccard 0.44) and were more deprived, while LTFU hotspots overlapped less (0.20) with little deprivation association; least-deprived-quintile rates would reduce notifications by 34% and deaths by 28%, and 2013–15 hotspots predicted 41% of notifications in 2022–24.

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