This study describes the tuberculosis situation in São Gabriel da Cachoeira, Amazonas State, Brazil, from 1997 to 2002. The county, which has a predominantly Indian population, is a relevant tuberculosis area in Amazonas, since the infection rate is 2.4 to 4 times that of the overall State and national rates. The statistical analyses used to assess its association with age, gender, and clinical form showed differences in the endemic behavior, comparing the urban and rural incidence rates. Males had higher standardized incidence rates than females in both the urban and rural areas. The most heavily affected age group was greater than 50 years, but the rate among individuals under 15 years was above the overall national rate, in addition to presenting different severity levels in the rural sub-areas that were studied. The situation can be explained mainly by inequalities in access to health services, which paradoxically appear to show lower case-resolving capacity in urban areas of the county.
Tuberculosis; South American Indians; Health Inequalities
