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BACKGROUND

Tuberculosis (TB) remains a pressing public health issue, posing a significant threat to individuals' well-being and lives. This study delves into the TB incidence in Chinese mainland during 2014-2021, aiming to gain deeper insights into their epidemiological characteristics and explore macro-level factors to enhance control and prevention.

METHODS

TB incidence data in Chinese mainland from 2014 to 2021 were sourced from the National Notifiable Disease Reporting System (NNDRS). A two-stage distributed lag nonlinear model (DLNM) was constructed to evaluate the lag and non-linearity of daily average temperature (℃, Atemp), average relative humidity (%, ARH), average wind speed (m/s, AWS), sunshine duration (h, SD) and precipitation (mm, PRE) on the TB incidence. A spatial panel data model was used to assess the impact of demographic, medical and health resource, and economic factors on TB incidence.

RESULTS

A total of 6,587,439 TB cases were reported in Chinese mainland during 2014-2021, with an average annual incidence rate of 59.17/100,000. The TB incidence decreased from 67.05/100,000 in 2014 to 46.40/100,000 in 2021, notably declining from 2018 to 2021 (APC = -8.87%, 95% CI: -11.97, -6.85%). TB incidence rates were higher among males, farmers, and individuals aged 65 years and older. Spatiotemporal analysis revealed a significant cluster in Xinjiang, Qinghai, and Xizang from March 2017 to June 2019 (RR = 3.94, P < 0.001). From 2014 to 2021, the proportion of etiologically confirmed cases increased from 31.31% to 56.98%, and the time interval from TB onset to diagnosis shortened from 26 days (IQR: 10-56 days) to 19 days (IQR: 7-44 days). Specific meteorological conditions, including low temperature (< 16.69℃), high relative humidity (> 71.73%), low sunshine duration (< 6.18 h) increased the risk of TB incidence, while extreme low wind speed (< 2.79 m/s) decreased the risk. The spatial Durbin model showed positive associations between TB incidence rates and sex ratio (β = 1.98), number of beds in medical and health institutions per 10,000 population (β = 0.90), and total health expenses (β = 0.55). There were negative associations between TB incidence rates and population (β = -1.14), population density (β = -0.19), urbanization rate (β = -0.62), number of medical and health institutions (β = -0.23), and number of health technicians per 10,000 population (β = -0.70).

CONCLUSIONS

Significant progress has been made in TB control and prevention in China, but challenges persist among some populations and areas. Varied relationships were observed between TB incidence and factors from meteorological, demographic, medical and health resource, and economic aspects. These findings underscore the importance of ongoing efforts to strengthen TB control and implement digital/intelligent surveillance for early risk detection and comprehensive interventions.

BACKGROUND

METHODS

RESULTS

CONCLUSIONS

背景

结核病（TB）仍然是一个紧迫的公共卫生问题，对个人的健康和生命构成重大威胁。本研究深入探讨了 2014-2021 年中国大陆的结核病发病率，旨在更深入地了解其流行病学特征，并探讨宏观层面的因素，以加强控制和预防。

方法

从国家法定传染病报告系统（NNDRS）获取 2014-2021 年中国大陆的结核病发病率数据。构建两阶段分布式滞后非线性模型（DLNM），以评估日平均温度（℃，Atemp）、平均相对湿度（%，ARH）、平均风速（m/s，AWS）、日照时间（h，SD）和降水（mm，PRE）对结核病发病率的滞后和非线性影响。使用空间面板数据模型评估人口统计学、医疗和卫生资源以及经济因素对结核病发病率的影响。

结果

2014-2021 年中国大陆共报告 6587439 例结核病病例，年均发病率为 59.17/10 万。结核病发病率从 2014 年的 67.05/10 万下降到 2021 年的 46.40/10 万，特别是 2018 年至 2021 年（APC=−8.87%，95%CI：−11.97，−6.85%）显著下降。男性、农民和 65 岁及以上人群的结核病发病率较高。时空分析显示，2017 年 3 月至 2019 年 6 月，新疆、青海和西藏地区存在显著的聚集性（RR=3.94，P<0.001）。2014 年至 2021 年，病因确诊病例的比例从 31.31%增加到 56.98%，结核病发病到确诊的时间间隔从 26 天（IQR：10-56 天）缩短至 19 天（IQR：7-44 天）。特定的气象条件，包括低温（<16.69℃）、高相对湿度（>71.73%）、低日照时间（<6.18 h），增加了结核病发病的风险，而极端低风速（<2.79 m/s）则降低了发病风险。空间杜宾模型显示，结核病发病率与性别比例（β=1.98）、每万人拥有的医疗机构床位数（β=0.90）和卫生总费用（β=0.55）呈正相关。结核病发病率与人口（β=−1.14）、人口密度（β=−0.19）、城市化率（β=−0.62）、医疗机构数量（β=−0.23）和每万人拥有的卫生技术人员数（β=−0.70）呈负相关。