Young men, social inequality drive tuberculosis in Brazilian city

Tuberculosis remains a persistent public health problem, especially in places marked by social inequality. In a new study led by Ícaro Raony, researchers looked back over 11 years of reported cases in São José do Rio Preto, a medium-sized city in southeastern Brazil, to map who is getting sick and how the disease is behaving in the community. The team examined 2,017 cases recorded between 2014 and 2024 to build a clear picture of the city’s tuberculosis burden. The analysis showed a strong concentration of cases in adult men: males outnumbered females by about three to one, and nearly half of all cases (46.9%) occurred in people aged 25–44. Most patients had not completed high school (82.3%), suggesting links between TB and limited education or related socioeconomic factors. The chest form of the disease, pulmonary tuberculosis, accounted for the bulk of cases (78.5%). By focusing on a complete decade of local data, the study paints a detailed portrait of who is most affected in this Brazilian urban center and lays the groundwork for targeted interventions.

The study used a retrospective review of notified tuberculosis cases from 2014 through 2024 to quantify demographic patterns, clinical forms, and coexisting health problems. Of the 2,017 cases analyzed, pulmonary TB was the most common presentation at 78.5%. Men comprised about three times as many patients as women, and adults aged 25–44 made up 46.9% of cases. Educational shortfalls were common: 82.3% had not finished high school. The work also documented high rates of comorbid conditions and behaviors that complicate care: diabetes was present in 8.5% of patients, alcohol-use disorder in 22.8%, current smoking in 38.7%, illicit drug use in 24.1%, and HIV infection in 13.8%. Statistical analysis identified strong relationships between conditions and outcomes: HIV co-infection was strongly associated with extrapulmonary TB (OR = 4.3, 99% CI = 3.1–6.2). TB-related death was linked to older age and diabetes (OR = 2.9, 99% CI = 1.5–5.8). Notably, patients receiving directly observed treatment experienced far fewer TB-related deaths (OR = 0.03; 99% CI = 0.0–0.1).

These findings have clear implications for health policy and local practice. The concentration of TB in young adult men with limited education points to social vulnerability as a driving force, suggesting that medical measures alone will not be sufficient to control the disease. High rates of smoking, alcohol and illicit drug use, diabetes, and HIV among people with TB indicate that integrated care — combining tuberculosis treatment with services for chronic disease management, addiction support, and HIV care — could improve outcomes. The strong protective signal associated with directly observed treatment underlines the value of ensuring that patients complete therapy under supervision, a strategy linked here to dramatically lower odds of death. For public health officials in São José do Rio Preto, the study highlights where to focus: outreach to socially vulnerable neighborhoods, tailored services for men in the 25–44 age group, and programs that address the intersecting health problems that fuel poor TB outcomes. Above all, the analysis by Ícaro Raony and colleagues stresses that tackling social determinants and comorbid conditions is essential to reduce tuberculosis burden in the city.