West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Ren Min Nan Road, Chengdu, 610041, Sichuan, China.
Medical College, Northwest Minzu University, Lanzhou, China.
Infect Dis Poverty. 2020 Feb 17;9(1):5. doi: 10.1186/s40249-020-0621-x.
Internal migration places individuals at high risk of contracting tuberculosis (TB). However, there is a scarcity of national-level spatial analyses regarding the association between TB and internal migration in China. In our research, we aimed to explore the spatial variation in cases of sputum smear-positive pulmonary TB (SS + PTB) in China; and the associations between SS + PTB, internal migration, socioeconomic factors, and demographic factors in the country between 2005 and 2015.
Reported cases of SS + PTB were obtained from the national PTB surveillance system database; cases were obtained at the provincial level. Internal migration data were extracted from the national population sampling survey and the census. Spatial autocorrelations were explored using the global Moran's statistic and local indicators of spatial association. The spatial temporal analysis was performed using Kulldorff's scan statistic. Fixed effects regression was used to explore the association between SS + PTB and internal migration.
A total of 4 708 563 SS + PTB cases were reported in China between 2005 and 2015, of which 3 376 011 (71.7%) were male and 1 332 552 (28.3%) were female. There was a trend towards decreasing rates of SS + PTB notifications between 2005 and 2015. The result of global spatial autocorrelation indicated that there were significant spatial correlations between SS + PTB rate and internal migration each year (2005-2015). Spatial clustering of SS + PTB cases was mainly located in central and southern China and overlapped with the clusters of emigration. The proportions of emigrants and immigrants were significantly associated with SS + PTB. Per capita GDP and education level were negatively associated with SS + PTB. The internal migration flow maps indicated that migrants preferred neighboring provinces, with most migrating for work or business.
This study found a significant spatial autocorrelation between SS + PTB and internal migration. Both emigration and immigration were statistically associated with SS + PTB, and the association with emigration was stronger than that for immigration. Further, we found that SS + PTB clusters overlapped with emigration clusters, and the internal migration flow maps suggested that migrants from SS + PTB clusters may influence the TB epidemic characteristics of neighboring provinces. These findings can help stakeholders to implement effective PTB control strategies for areas at high risk of PTB and those with high rates of internal migrants.
国内迁移使个人面临罹患结核病（TB）的高风险。然而，中国针对国内迁移与结核病之间关联的全国性空间分析相对较少。在本研究中，我们旨在探究 2005 年至 2015 年间中国痰涂片阳性肺结核（SS+PTB）病例的空间变化；以及 SS+PTB 与国内迁移、社会经济因素和人口统计因素之间的关系。
从国家肺结核监测系统数据库中获取 SS+PTB 报告病例；病例获取于省级水平。国内迁移数据取自全国人口抽样调查和人口普查。采用全局 Moran 统计量和局部空间关联指标来探索空间自相关。采用 Kulldorff 的扫描统计量进行时空分析。采用固定效应回归来探究 SS+PTB 与国内迁移之间的关系。
2005 年至 2015 年间，中国共报告了 4708563 例 SS+PTB 病例，其中 3376011 例（71.7%）为男性，1332552 例（28.3%）为女性。2005 年至 2015 年间，SS+PTB 报告率呈下降趋势。全局空间自相关结果表明，每年 SS+PTB 率与国内迁移之间均存在显著的空间相关性（2005-2015 年）。SS+PTB 病例的空间聚类主要位于中国中部和南部，与移民群体的聚类重叠。移民和非移民的比例与 SS+PTB 显著相关。人均国内生产总值和教育水平与 SS+PTB 呈负相关。国内迁移流动图表明，移民倾向于相邻省份，大部分人是为了工作或经商而迁移。
本研究发现 SS+PTB 与国内迁移之间存在显著的空间自相关。移民和非移民均与 SS+PTB 存在统计学关联，且与移民的关联比非移民更为显著。此外，我们发现 SS+PTB 聚类与移民聚类重叠，国内迁移流动图表明 SS+PTB 聚类的移民可能会影响邻近省份的结核病流行特征。这些发现有助于利益相关者为高风险结核病地区和高国内移民率地区实施有效的肺结核控制策略。
