Pulmonary tuberculosis remains a serious public health problem in Brazil, with profound regional inequalities. Studies show that socioeconomic factors, access to health services, and population density are critical determinants (Maciel et al., 2018; Otter et al., 2020). This study analyzed temporal trends and spatial distribution of confirmed pulmonary TB cases in Rio Grande do Sul between 2014 and 2024, aiming to identify epidemiological patterns. Secondary data were extracted from SINAN/DataSUS, considering confirmed pulmonary TB cases (relapse, re-entry after loss to follow-up, or transfer). A longitudinal analysis (2014–2024) was performed across 30 Health Regions (CIR), using descriptive statistics (absolute/relative frequencies, percentage variation) and comparison with historical averages. A total of 17,829 cases were recorded in the period, with a biphasic pattern: an initial 10.0% reduction between 2014 (1,475 cases) and 2018 (1,327 cases), followed by a sharp 58.6% increase from 2019 to 2024 (1,660 to 2,103 cases), reaching a peak in 2023 (2,138 cases). A pandemic effect was observed in 2020 (13.3% drop vs. 2019), with post-2021 recovery surpassing pre-pandemic levels. Spatial distribution was markedly asymmetric: Region 43010 (Capital and Vale do Gravataí) accounted for 46.3% of the total (n=8,254), while seven peripheral regions had residual burdens (50% compared with the 2014–2023 historical average, notably 43011 (Sete Povos das Missões) with 127% above the annual average (25 cases in 2024 vs. average of 11), and 43022 (Pampa) with 90% (19 cases vs. average of 10). The resurgence of pulmonary TB in Rio Grande do Sul after 2018, with marked regional disparities, reflects structural failures in disease control. Hyperendemicity in the Metropolitan Region (43010) suggests gaps in primary care and urban determinants, while outbreaks in peripheral regions (e.g., 43011 and 43022) point to emerging social vulnerabilities. Although stabilization occurred in 2024 (-1.6% vs. 2023), levels remain 26.7% higher than 2019, demanding: (1) strengthened surveillance in critical regions; (2) local studies on access barriers; and (3) integration with social determinant programs. Persistence of cases in low-prevalence regions reinforces the need for territorialized approaches aligned with recommendations of the National Plan to End Tuberculosis.
Skonetzky et al. (Sun,) studied this question.