Tuberculosis among Older Adults in Brazil: Recent Changes in Incidence

Abstract Background Tuberculosis (TB) remains a major public health concern, particularly among older adults, who are more vulnerable to severe disease and adverse outcomes. Although recent studies have described temporal trends in TB incidence among older adults in Brazil, important gaps remain regarding recent changes, regional differences, and the municipal distribution of the disease. This study examined temporal and spatial patterns of TB incidence among older adults in Brazil and compared incidence rates between older adults and adults. Methods We conducted an ecological study using TB notifications from the Brazilian Notifiable Diseases Information System (Sinan) and population estimates from the Brazilian Institute of Geography and Statistics (IBGE) for 2012–2024. Newly notified pulmonary TB cases, including cases with concurrent extrapulmonary involvement, were selected among older adults (≥ 65 years) and adults (15–64 years). Crude incidence rates and incidence rate ratios (IRRs; older adults/adults) were calculated. Rates were projected to 2030 using Holt’s double exponential smoothing. Municipal maps were produced in R using the sf and tmap packages. Results A total of 84,880 TB cases were recorded among older adults in Brazil between 2012 and 2024, corresponding to an annual average of 6,529 cases. Projections indicate increasing incidence rates in all five regions by 2030. The North is projected to retain the highest rate (89.75 per 100,000 older adults; 95% CI: 87.84–91.66), whereas the South is expected to have the lowest (27.08; 95% CI: 24.54–29.62). The Southeast is projected to experience the largest increase, reaching 44.59 per 100,000 older adults (95% CI: 40.53–48.66). IRRs varied substantially across regions: they remained above 1.0 in the North and Central-West, were close to 1.0 in the Northeast, and remained below 1.0 in the South and Southeast. Municipal maps showed marked spatial heterogeneity, particularly in the North and parts of the Northeast. Conclusions TB incidence among older adults in Brazil varies substantially over time and across regions and municipalities. The projected increase by 2030, together with the geographic differences identified, underscores the need to strengthen surveillance, promote timely diagnosis, and tailor prevention and control strategies to local epidemiological conditions while taking population aging into account.