{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T01:58:42Z","timestamp":1790819922750,"version":"4.1.0"},"reference-count":14,"publisher":"FapUNIFESP (SciELO)","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Braz. J. Biol."],"abstract":"<jats:p>Abstract Tuberculosis remains a major public health concern in Brazil, particularly in the Amazon region, where its distribution is shaped by persistent social inequalities and environmental pressures. This study analyzed the spatial and sociodemographic dynamics of tuberculosis in the state of Par\u00e1, Northern Brazil, between 2018 and 2022. A total of 26,127 confirmed cases were identified through the Notifiable Diseases Information System and the National Registry of Health Establishments. We applied empirical Bayes smoothing and Kulldorff\u2019s spatial scan statistic to detect high-risk territorial clusters and used multilevel logistic regression to assess individual and contextual predictors of unfavorable treatment outcomes. The disease primarily affected men, young adults aged 15-49 years, individuals with low educational attainment, and those self-identified as of mixed race. Spatial analysis revealed persistent high-risk clusters in the Metropolitan Region of Bel\u00e9m and a progressive expansion into Southeastern and South-Central municipalities. Lower education and Black or mixed-race identity were independently associated with a higher likelihood of unfavorable outcomes. The findings underscore the importance of integrating spatial epidemiology with multilevel modeling to uncover both individual and territorial determinants of tuberculosis. They highlight the need for geographically targeted interventions, the expansion of primary care services, and intersectoral public policies aimed at mitigating structural vulnerabilities in the Brazilian Amazon. Our results provide evidence to support precision public health strategies and enhance local planning in regions of high social and environmental risk.<\/jats:p>","DOI":"10.1590\/1519-6984.296615","type":"journal-article","created":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T15:05:03Z","timestamp":1755270303000},"source":"Crossref","is-referenced-by-count":1,"title":["Spatial and social determinants of tuberculosis in the Brazilian Amazon: a five-year multilevel and cluster-based analysis in Par\u00e1 state, 2018-2022"],"prefix":"10.1590","volume":"85","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9451-666X","authenticated-orcid":false,"given":"C.","family":"Andrade-Sales","sequence":"first","affiliation":[{"name":"Universidade Federal do Sul e Sudeste do Par\u00e1,  Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0602-7282","authenticated-orcid":false,"given":"P. A.","family":"Mendon\u00e7a-Cavalcante","sequence":"additional","affiliation":[{"name":"Universidade Federal do Sul e Sudeste do Par\u00e1,  Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5388-6755","authenticated-orcid":false,"given":"A. P.","family":"Sim\u00f5es-Castro","sequence":"additional","affiliation":[{"name":"Universidade Federal do Sul e Sudeste do Par\u00e1,  Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6641-4618","authenticated-orcid":false,"given":"M. P.","family":"Moreira-Sena","sequence":"additional","affiliation":[{"name":"Universidade Federal do Par\u00e1,  Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9282-280X","authenticated-orcid":false,"given":"A. P.","family":"Galv\u00e3o-Fonseca","sequence":"additional","affiliation":[{"name":"Universidade Federal do Sul e Sudeste do Par\u00e1,  Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7661-1615","authenticated-orcid":false,"given":"A. G. N.","family":"Cardoso-Mello","sequence":"additional","affiliation":[{"name":"Universidade Federal do Par\u00e1,  Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9364-3990","authenticated-orcid":false,"given":"C. A.","family":"Abreu-Alberio","sequence":"additional","affiliation":[{"name":"Universidade Federal do Par\u00e1,  Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4842-8762","authenticated-orcid":false,"given":"J. L.","family":"Fernandes-Vieira","sequence":"additional","affiliation":[{"name":"Universidade Federal do Par\u00e1,  Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9363-5766","authenticated-orcid":false,"given":"L. W.","family":"Pereira-Sena","sequence":"additional","affiliation":[{"name":"Universidade Federal do Sul e Sudeste do Par\u00e1,  Brasil; Universidade Federal do Sul e Sudeste do Par\u00e1,  Brasil; Universidade Federal do Par\u00e1,  Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2025]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"2423","DOI":"10.1590\/1413-81232020256.1.10502020","article-title":"Medidas de distanciamento social no controle da pandemia de COVID-19: potenciais impactos e desafios no Brasil","volume":"25","author":"AQUINO E.M.L.","year":"2020","journal-title":"Ciencia & Saude Coletiva"},{"key":"ref2","series-title":"Manual de recomenda\u00e7\u00f5es para o controle da tuberculose no Brasil","year":"2019","edition":"2."},{"issue":"12","key":"ref3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0001482","article-title":"The community as an active part in the implementation of interventions for the prevention and care of tuberculosis: a scoping review","volume":"3","author":"CHAVEZ-RIMACHE L.","year":"2023","journal-title":"PLOS Global Public Health"},{"issue":"8","key":"ref4","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.3855\/jidc.13674","article-title":"Environmental and social effects on the incidence of tuberculosis in three Brazilian municipalities and in Federal District","volume":"15","author":"FERNANDES F.M.C.","year":"2021","journal-title":"Journal of Infection in Developing Countries"},{"key":"ref5","doi-asserted-by":"crossref","DOI":"10.1590\/s1980-220x2019039603688","article-title":"Tuberculosis in the street population: a systematic review","volume":"55","author":"HINO P.","year":"2021","journal-title":"Revista da Escola de Enfermagem da USP."},{"key":"ref6","series-title":"Estimativas da popula\u00e7\u00e3o residente para os munic\u00edpios e unidades da federa\u00e7\u00e3o brasileira com dados de refer\u00eancia em 1\u00ba de julho de 2020","year":"2020"},{"issue":"Pt C","key":"ref7","article-title":"The impact of climate change on the risk factors for tuberculosis: a systematic review","volume":"212","author":"KHARWADKAR S.","year":"2022","journal-title":"Environmental Research"},{"key":"ref8","doi-asserted-by":"crossref","DOI":"10.1016\/j.envres.2024.118436","article-title":"Impact of extreme weather events on mental health in South and Southeast Asia: a two decades of systematic review of observational studies","volume":"250","author":"PATWARY M.M.","year":"2024","journal-title":"Environmental Research"},{"issue":"10","key":"ref9","first-page":"77","article-title":"Desenvolvimento e vulnerabilidade social em munic\u00edpios minerados: uma an\u00e1lise para o estado do Par\u00e1","volume":"5","author":"PEREIRA H.O.","year":"2022","journal-title":"Revista de Desenvolvimento Econ\u00f4mico"},{"issue":"10311","key":"ref10","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1016\/S0140-6736(21)01787-6","article-title":"The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future","volume":"398","author":"ROMANELLO M.","year":"2021","journal-title":"Lancet"},{"key":"ref11","article-title":"Impact of climate change and social determinants on the spatial and epidemiological distribution of tuberculosis in the state of Par\u00e1: a perspective for COP 30","volume":"85","author":"TAVARES-COH\u00c9N G.A.","year":"2025","journal-title":"Brazilian Journal of Biology = Revista Brasileira de Biologia"},{"issue":"2","key":"ref12","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.pulmoe.2020.12.012","article-title":"Tuberculosis and COVID-19 interaction: a review of biological, clinical and public health effects","volume":"27","author":"VISCA D.","year":"2021","journal-title":"Pulmonology"},{"key":"ref13","series-title":"Global tuberculosis report 2023","year":"2023"},{"key":"ref14","article-title":"Spatial overlap between latent Mycobacterium tuberculosis infection and Venezuelan migrants","author":"ZAMBONIN F.","year":"2024","journal-title":"Research Square"}],"container-title":["Brazilian Journal of Biology"],"original-title":["Determinantes espaciais e sociais da tuberculose na Amaz\u00f4nia brasileira: uma an\u00e1lise multin\u00edvel e baseada em clusters de cinco anos no estado do Par\u00e1, 2018-2022"],"link":[{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_pdf&pid=S1519-69842025000100290&tlng=en","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T15:05:05Z","timestamp":1755270305000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S1519-69842025000100290&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":14,"alternative-id":["S1519-69842025000100290"],"URL":"https:\/\/doi.org\/10.1590\/1519-6984.296615","relation":{},"ISSN":["1678-4375","1519-6984"],"issn-type":[{"value":"1678-4375","type":"electronic"},{"value":"1519-6984","type":"print"}],"subject":[],"published":{"date-parts":[[2025]]},"article-number":"e296615"}}