{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T07:12:09Z","timestamp":1775891529041,"version":"3.50.1"},"reference-count":45,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Funda\u00e7\u00e3o de Amparo \u00e0 Ci\u00eancia e Tecnologia do Estado de Pernambuco (FACEPE)","award":["ibpg-0388-4.06\/21"],"award-info":[{"award-number":["ibpg-0388-4.06\/21"]}]},{"name":"National Council for Scientific and Technological Development (CNPq)","award":["ibpg-0388-4.06\/21"],"award-info":[{"award-number":["ibpg-0388-4.06\/21"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>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. Objective: 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. Methods: 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\u2019s Local Empirical Bayesian Smoothing Method was used. Risk ratios were calculated to estimate the magnitude of association between income strata and incidence rates. Results: 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. Conclusions: 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.<\/jats:p>","DOI":"10.3390\/ijerph22040545","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T07:47:44Z","timestamp":1743580064000},"page":"545","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Spatial Analysis of Tuberculosis, COVID-19, and Tuberculosis\/COVID-19 Coinfection in Recife, PE, Brazil"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7506-1673","authenticated-orcid":false,"given":"Alene Bezerra Ara\u00fajo","family":"Silva","sequence":"first","affiliation":[{"name":"Graduate Program in Health Sciences, Faculty of Medical Sciences, University of Pernambuco, Recife CEP 50100-010, PE, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wayner Vieira de","family":"Souza","sequence":"additional","affiliation":[{"name":"Department of Public Health, Aggeu Magalh\u00e3es Research Center, Fiocruz, Recife CEP 50.740-465, PE, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7374-1016","authenticated-orcid":false,"given":"Jos\u00e9 Constantino Silveira","family":"J\u00fanior","sequence":"additional","affiliation":[{"name":"Aggeu Magalh\u00e3es Research Center, Fiocruz, Recife CEP 50.740-465, PE, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliana Silva de","family":"Santana","sequence":"additional","affiliation":[{"name":"Applied Cellular and Molecular Biology, University of Pernambuco, Recife CEP 50100-010, PE, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo Arraes de Alencar","family":"Ximenes","sequence":"additional","affiliation":[{"name":"Department of Tropical Medicine, Federal University of Pernambuco, Recife CEP 50670-901, PE, Brazil"},{"name":"Department of Medical Clinic, University of Pernambuco, Recife CEP 50100-010, PE, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2023, August 17). 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