| BackgroundTuberculosis(TB)is a chronic infectious disease caused by the infection of Mycobacterium TB,which has always been threatening human health seriously Global TB Report 2019 indicated that TB was still one of the top 10 causes of death worldwide and the leading cause among all infectious diseases(ranking above HIV/AIDS).Globally.nearly 10 million people fall ill with TB each year.TB burden varies enormously among countries.About 87%of TB cases all over the world are from 30 high TB burden countries including China.In 2018,there were about 866,000 new TB cases in China,accounting for 9%of new TB cases worldwide,which made China rank second in the worldSpatial epidemiology and ecological study are important parts of epidemiology methods.In terms of the control and elimination of TB,It is necessary to analyze the spatial distribution of TB,and explore influence factors related to the occurrence and prevalence of TB by means of ecological study.Objectives(1)To identify key areas of TB control by means of spatial analysis;(2)To identify the relationship between TB and ecological factors such as demographic characteristics,environmental factors and socio-economic factors,and then put forward suggestions for TB control and preventionMethodsWe collected TB surveillance data in China from 2013 to 2017,and described TB registration rate at county level,province level and country level.Spatial scanning was used to identify TB clusters.TB surveillance data were from the TB information management system of the Chinese center for disease control and prevention(CDC)According to the result of spatial scanning,we used purposive sampling method to select 9 ecological study sites.Descriptive anaylysis,Spearman rank correlation analysis and multi-level model were utilized to explore the relationship between TB registration rate and demographic characteristics,environmental factors and socio-economic factors.SaTScan9.6,Arcgis10.2,SAS9.4 and Excel2013 were used in our research.ResultsFrom 2013 to 2017,the national TB registration rate decreased year by year.Xinjiang,Tibet,Guizhou and Hunan consistently ranked top five in terms of TB registration rate.Counties with TB registration rate of more than 200 per 100,000 were mainly located in Xinjiang,Tibet,Qinghai and Guizhou provinces.TB spatial clusters were mainly distributed in western and central provinces of China.In the ecological study,Spearman rank correlation anlysis showed that annual participation,normalized vegetation index(NDVI),per capita GDP,per capita rural net income,number of licensed(assistant)physicians per thousand population(NLP),special expenses for TB control(SETC),and the proportion of staff with bachelor degree or above in the CDC(PSBDA)were negatively correlated with TB registration rate.Annual sunshine hours,PM 10 and PM2.5 were positively correlated with TB registration rate.The multi-level model showed that TB registration rate decreased with the increase of urbanization rate,annual sunshine hours,annual participation,NDVI,per capita rural net income and special expenses for TB control.And it increased with the increase of average temperature,annual average relative humidity,PM 10,and the proportion of staff in the CDC with bachelor degree or above.ConclusionsTB clusters in China are mainly distributed in western and central provinces,and the TB epidemic in adjacent counties affects each other.Joint TB control and prevention of the clusters should be strengthened.Due to the severe situation of TB epidemic in Xinjiang,Tibet,Guizhou and other western provinces,the treatment and management of TB patients should be enhanced.TB registration rate increases with the increase of average temperature and annual average relative humidity,and decreases with the increase of.anual sunshine hours,anual precipitation,and NDVI.Air pollution is a risk factor of the spread and prevalence of TB.PM10 is the main pollutant leading to the TB epidemicTB epidemic declined with the increase of per capita net income of rural residents,and SETC. |
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