Spatiotemporal Patterns of Tuberculosis in Hunan Province, China

Kefyalew Addis Alene, Zuhui Xu, Liqiong Bai, Hengzhong Yi, Yunhong Tan, Darren J. Gray, Kerri Viney and Archie C. A. Clements
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Kefyalew Addis Alene: Faculty of Health Sciences, Curtin University, Perth 6102, Australia
Zuhui Xu: Department of Tuberculosis Control, Tuberculosis Control Institute of Hunan Province, Changsha 410000, China
Liqiong Bai: Department of Director’s Office, Hunan Chest Hospital, Changsha 410013, China
Hengzhong Yi: Department of MDR-TB, Internal Medicine, Hunan Chest Hospital, Changsha 410013, China
Yunhong Tan: Department of MDR-TB, Internal Medicine, Hunan Chest Hospital, Changsha 410013, China
Darren J. Gray: Research School of Population Health, the Australian National University, Canberra 2601, Australia
Kerri Viney: Research School of Population Health, the Australian National University, Canberra 2601, Australia
Archie C. A. Clements: Faculty of Health Sciences, Curtin University, Perth 6102, Australia

IJERPH, 2021, vol. 18, issue 13, 1-12

Abstract: Tuberculosis (TB) is the leading cause of death from a bacterial pathogen worldwide. China has the third highest TB burden in the world, with a high reported burden in Hunan Province (amongst others). This study aimed to investigate the spatial distribution of TB and identify socioeconomic, demographic, and environmental drivers in Hunan Province, China. Numbers of reported cases of TB were obtained from the Tuberculosis Control Institute of Hunan Province, China. A wide range of covariates were collected from different sources, including from the Worldclim database, and the Hunan Bureau of Statistics. These variables were summarized at the county level and linked with TB notification data. Spatial clustering of TB was explored using Moran’s I statistic and the Getis–Ord statistic. Poisson regression models were developed with a conditional autoregressive (CAR) prior structure, and with posterior parameters estimated using a Bayesian approach with Markov chain Monte Carlo (MCMC) simulation. A total of 323,340 TB cases were reported to the Hunan TB Control Institute from 2013 to 2018. The mean age of patients was 51.7 years (SD + 17.6 years). The majority of the patients were male (72.6%, n = 234,682) and had pulmonary TB (97.5%, n = 315,350). Of 319,825 TB patients with registered treatment outcomes, 306,107 (95.7%) patients had a successful treatment outcome. The annual incidence of TB decreased over time from 85.5 per 100,000 population in 2013 to 76.9 per 100,000 population in 2018. TB case numbers have shown seasonal variation, with the highest number of cases reported during the end of spring and the beginning of summer. Spatial clustering of TB incidence was observed at the county level, with hotspot areas detected in the west part of Hunan Province. The spatial clustering of TB incidence was significantly associated with low sunshine exposure (RR: 0.86; 95% CrI: 0.74, 0.96) and a low prevalence of contraceptive use (RR: 0.88; 95% CrI: 0.79, 0.98). Substantial spatial clustering and seasonality of TB incidence were observed in Hunan Province, with spatial patterns associated with environmental and health care factors. This research suggests that interventions could be more efficiently targeted at locations and times of the year with the highest transmission risk.

Keywords: tuberculosis; spatial analysis; spatiotemporal; China (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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