Analysis On The Prevalence Of Pulmonary Tuberculosis In Kashi

Objective:The purpose of this study was to investigate the epidemiological distribution of new active pulmonary tuberculosis（PTB）in Kashi,and to explore the influencing factors of tuberculosis incidence,especially the influence of environmental factors on the incidence of PTB.Methods:1.In this study,1940622 participants in the 2017 national health examination in Kashi area were selected as the research objects.After sorting out the demographic data,the epidemiological distribution of newly diagnosed active PTB in Kashi area in 2017 was analyzed in terms of gender,age,occupation and county and urban areas.2.Using the mean data of various environmental factors in Kashi area from 2014to 2017 as the long-term environmental exposure index,the data set including 22 traditional risk factors and14 environmental impact factors was constructed according to the information matching based on the geographic annotation information of population addresses.3.Exposome-wide Association Study（Ex WAS）was used to construct a univariate regression model of influencing factors of PTB incidence,and to explore the association between single factor exposure and newly diagnosed active PTB.4.Spearman correlation was used to analyze the correlation among various environmental factors.5.Adaptive Elastic-net（AENET）penalty regression method was used to construct a multi-factor regression model of influencing factors of PTB incidence,and the Directed Acyclic Graph（DAGs）was screened for minimum confounding factors.To investigate the association between multi-factor co-exposure and newly active PTB.6.Extreme Gradient Boosting（XGBoost）method was used to rank the relative importance of the influencing factors and analyze the influence degree of each influencing factor on the incidence of PTB.7.The robustness of the constructed model was tested by comparing the sensitivity analysis with the main results.Results:1.In 2017,there were 9,759 newly untreated newly active PTB in Kashi,with an incidence rate of502.9/100,000.In terms of the distribution of counties and urban areas,the number of cases was the highest in Shache County,accounting for 26.43%,followed by Yingjisha County（14.41%）and Maigaiti County（9.16%）.The highest incidence rate was in Yingjisha County（888.32/100,000）,followed by Maigaiti County（754.07/100,000）and Yuepuhu County（698.82/100,000）.In terms of gender distribution,the ratio of male to female was 1:0.91,and the ratio of female was slightly higher.In terms of age distribution,middle-aged and old people were the majority,mainly concentrated in the age range of 50 to 70 years old,the incidence rate was 81.53%;In terms of occupational distribution,farmers accounted for the majority of cases,accounting for 87.6%.2.The correlation analysis results showed that there were interactions among various environmental factors,and the correlation coefficient was-0.78-0.69.3.After adjusting for the minimum confounding factors screened in the DAGs chart,including age,sex,ethnicity,economic status,education level and living environment,the results of multivariate regression analysis of tuberculosis incidence showed that:In terms of environmental factors,higher Nitrogen dioxide（NO₂）,higher Carbon monoxide（CO）and higher wind speed were risk factors for newly active PTB.Higher Sulfur dioxide（SO₂）,higher Artificial light at nigh（ALAN）,higher Proportion of forests,shrublands and grasslands（FSG%）and higher altitude were protective factors for newly active PTB.In terms of traditional risk factors,age,cardiovascular disease,low body weight,lack of physical activity and unbalanced diet were risk factors for newly active PTB.4.Ranking results of relative importance of influencing factors:age,cardiovascular disease and low body weight were the main traditional risk factors,and SO₂,NO₂and CO were the main environmental influencing factors.5.The Ex WAS,AENET penalty regression models and XGBoost models constructed in this study had good robustness in sensitivity analysis,which was consistent with the main results.Conclusions:1.In 2017,the incidence of newly untreated newly active PTB in Kashi region was 502.9 per100,000.Shache County,Yingjisha County and Maigaiti County had a large number of PTB cases and a high incidence.In Kashi region,women,middle-aged and old people and farmers accounted for a higher proportion of PTB patients.2.In addition to the traditional risk factors such as age,cardiovascular disease,low body weight,physical inactivity,and diet habits,the incidence of PTB was greatly influenced by environmental factors such as NO₂,CO,SO₂,ALAN,FSG%and altitude.