Tuberculosis, being an aerogenic and socially significant disease, can act as a model when choosing methods for spatial assessment of the spread of other airborne diseases (such as COVID-19, etc.). The modern tuberculosis service in Russia is based on the territorial principle: one or more tuberculosis institutions are assigned to one administrative unit, whose tasks include conducting an epidemiological assessment of the spread of diseases in the territory. Data exchange between neighboring territories is limited. This makes it difficult to conduct interdisciplinary research for the territories of agglomerations. The purpose of this study was to primarily study the spatial features of the spread of tuberculosis in the territories of the agglomeration of St. Petersburg and the Leningrad Region, as well as to determine the risk areas for the spread of tuberculosis. The Federal Register of Tuberculosis Patients of two subjects was used as a source of information on tuberculosis cases. Information about patients included both newly diagnosed cases and recurrences of tuberculosis. A hypothesis has been put forward about the existence of “hidden” risk territories on the border of St. Petersburg, associated with the metropolis, but administratively located in the Leningrad Region. The main method of determining risk territories was the spatial autocorrelation method based on the Moran index. Software data processing was performed using open source software products (NextGIS, GeoDa). In the end, the territories of potential risk of tuberculosis spread were identified from among the municipalities of the St. Petersburg agglomeration and the spatial relationship between the territories with different indicators in absolute cases of tuberculosis was determined. © 2025 Lomonosov Moscow State University. All rights reserved.