Geospatial Codistribution of Tuberculosis and Diabetes Mellitus in Indonesia

Abstract Background Tuberculosis (TB) and diabetes mellitus (DM) co-morbidity is a growing public health challenge, particularly in Indonesia, where TB incidence remains high and DM prevalence is increasing. DM co-morbidity is known to increase the risk of TB incidence and have negative effects on TB treatment outcomes. This study aims to analyze the geographical co-distribution of TB and DM and their sociodemographic determinants in Indonesia, to help inform public health response and targetting of screening programs. Methods Using data from the 2023 Indonesian Health Survey (SKI), we applied a Bayesian geostatistical model to estimate disease prevalence and assess associations with key sociodemographic factors. Results The proportion of the poor population is significantly associated with higher TB prevalence (0.106; 95% CrI: 0.039, 0.174), while population density has a strong positive correlation with DM prevalence (0.198; 95% CrI: 0.156, 0.241). Proportion of the poor population (-0.053; 95% CrI: -0.096, -0.009) and hospital services (-0.071; 95% CrI: -0.116, -0.027) show a negative association with DM prevalence. Conclusion Spatial analysis revealed significant regional variations, with high TB-DM co-distribution observed in rapidly urbanizing and high-poverty districts, including parts of West Java, East Java, Sumatra, and Kalimantan. These findings emphasize the need for strengthened TB-DM integration in healthcare services, especially in areas that have a high prevalence of both diseases. Strengthening integrated disease management strategies in local areas can help mitigate the burden of TB and DM in Indonesia.