Wu Zhuchao, Fu Gengfeng, Wen Qin, Wang Zheyue, Shi Lin-En, Qiu Beibei, Wang Jianming
Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, People's Republic of China.
Department of STI and HIV Control and Prevention, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, 210009, People's Republic of China.
Infect Drug Resist. 2023 Jun 23;16:4039-4052. doi: 10.2147/IDR.S412870. eCollection 2023.
Pulmonary tuberculosis (PTB) is a severe chronic communicable disease that causes a heavy disease burden in China. Human Immunodeficiency Virus (HIV) and PTB coinfection dramatically increases the risk of death. This study analyzes the spatiotemporal dynamics of HIV, PTB and HIV-PTB coinfection in Jiangsu Province, China, and explores the impact of socioeconomic determinants.
The data on all notified HIV, PTB and HIV-PTB coinfection cases were extracted from Jiangsu Provincial Center for Disease Control and Prevention. We applied the seasonal index to identify high-risk periods of the disease. Time trend, spatial autocorrelation and SaTScan were used to analyze temporal trends, hotspots and spatiotemporal clusters of diseases. The Bayesian space-time model was conducted to examine the socioeconomic determinants.
The case notification rate (CNR) of PTB decreased from 2011 to 2019 in Jiangsu Province, but the CNR of HIV and HIV-PTB coinfection had an upward trend. The seasonal index of PTB was the highest in March, and its hotspots were mainly distributed in the central and northern parts, such as Xuzhou, Suqian, Lianyungang and Taizhou. HIV had the highest seasonal index in July and HIV-PTB coinfection had the highest seasonal index in June, with their hotspots mainly distributed in southern Jiangsu, involving Nanjing, Suzhou, Wuxi and Changzhou. The Bayesian space-time interaction model showed that socioeconomic factor and population density were negatively correlated with the CNR of PTB, and positively associated with the CNR of HIV and HIV-PTB coinfection.
The spatial heterogeneity and spatiotemporal clusters of PTB, HIV and HIV-PTB coinfection are exhibited obviously in Jiangsu. More comprehensive interventions should be applied to target TB in the northern part. While in southern Jiangsu, where the economic level is well-developed and the population density is high, we should strengthen the prevention and control of HIV and HIV-PTB coinfection.
肺结核（PTB）是一种严重的慢性传染病，在中国造成沉重的疾病负担。人类免疫缺陷病毒（HIV）与PTB合并感染会显著增加死亡风险。本研究分析了中国江苏省HIV、PTB及HIV-PTB合并感染的时空动态，并探讨社会经济决定因素的影响。
从江苏省疾病预防控制中心提取所有报告的HIV、PTB及HIV-PTB合并感染病例的数据。我们应用季节性指数来确定疾病的高危时期。采用时间趋势、空间自相关和时空扫描法分析疾病的时间趋势、热点和时空聚集情况。采用贝叶斯时空模型来检验社会经济决定因素。
江苏省PTB的病例报告率（CNR）在2011年至2019年期间有所下降，但HIV及HIV-PTB合并感染的CNR呈上升趋势。PTB的季节性指数在3月最高，其热点主要分布在中部和北部，如徐州、宿迁、连云港和泰州。HIV的季节性指数在7月最高，HIV-PTB合并感染的季节性指数在6月最高，其热点主要分布在苏南，包括南京、苏州、无锡和常州。贝叶斯时空交互模型显示，社会经济因素和人口密度与PTB的CNR呈负相关，与HIV及HIV-PTB合并感染的CNR呈正相关。
江苏省PTB、HIV及HIV-PTB合并感染的空间异质性及时空聚集现象明显。应针对北部地区的结核病采取更全面的干预措施。而在经济发达、人口密度高的苏南地区，应加强HIV及HIV-PTB合并感染的防控工作。
