Temporal Trends in Tuberculosis Incidence in the 1st Health Region of Alagoas, Brazil (2001-2022).

The present study aimed to examine the temporal dynamics of tuberculosis incidence, mortality, and TB-HIV coinfection in the First Health Region of Alagoas from 2001 to 2022, with particular attention to sex-specific differences. The analysis revealed pronounced divergences between men and women. The male series exhibited significant positive autocorrelation and high interannual variability, indicating strong temporal dependence and heightened sensitivity to external disruptions such as the COVID-19 pandemic. The female series displayed a more regular pattern without autocorrelation. Although both sexes showed declining incidence, only the reduction among women reached statistical significance; the male trend remained unstable and inconclusive. Disease burden was consistently higher among men, who accounted for most cases and maintained incidence levels above elimination targets. TB-HIV coinfection increased in both sexes, with a sharper rise among men and a statistically significant upward trend among women, accompanied by a structural shift in 2010. Additional change points in 2014 and 2018 are likely to reflect alterations in surveillance or broader public health events. The weak performance of linear models underscores the role of persistent social determinants and inequities in healthcare access. Overall, the findings demonstrate that tuberculosis remains a major public health concern and that differentiated strategies by sex are essential for effective prevention and care.