Toward tuberculosis elimination by understanding epidemiologic characteristics and risk factors in Hainan Province, China

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Abstract

Background

The disease burden of tuberculosis (TB) was heavy in Hainan Province, China, and the information on transmission patterns was limited with few studies. This atudy aims to further explore the epidemiological characteristics and influencing factors of TB in Hainan Province, and thereby contribute valuable scientific evidences for TB elimination in Hainan Province.

Methods

The TB notification data in Hainan Province from 2013 to 2022 were collected from the Chinese National Disease Control Information System Tuberculosis Surveillance System, along with socio-economic data. The spatial–temporal and population distributions were analyzed, and spatial autocorrelation analysis was conducted to explore TB notification rate clustering. In addition, the epidemiological characteristics of the cases among in-country migrants were described, and the delay pattern in seeking medical care was investigated. Finally, a geographically and temporally weighted regression (GTWR) model was adopted to analyze the relationship between TB notification rate and socio-economic indicators. The tailored control suggestions in different regions for TB elimination was provided by understanding epidemiological characteristics and risk factors obtained by GTWR.

Results

From 2013 to 2022, 64,042 cases of TB were notified in Hainan Province. The estimated annual percentage change of TB notification rate in Hainan Province from 2013 to 2020 was − 6.88% [95% confidence interval ( CI): − 5.30%, − 3.69%], with higher rates in central and southern regions. The majority of patients were males (76.33%) and farmers (67.80%). Cases among in-country migrants primarily originated from Sichuan (369 cases), Heilongjiang (267 cases), Hunan (236 cases), Guangdong (174 cases), and Guangxi (139 cases), accounting for 53%. The majority (98.83%) of TB cases were notified through passive case finding approaches, with delay in seeking care. The GTWR analysis showed that gross domestic product per capita, the number of medical institutions and health personnel per 10,000 people were main factors affecting the high TB notification rates in some regions in Hainan Province. Different regional tailored measures such as more TB specialized hospitals were proposed based on the characteristics of each region.

Conclusions

The notification rate of TB in Hainan Province has been declining overall but still remained high in central and southern regions. Particular attention should be paid to the prevalence of TB among males, farmers, and out-of-province migrant populations. The notification rate was also influenced by economic development and medical conditions, indicating the need of more TB specialized hospitals, active surveillance and other tailored prevention and control measures to promote the progress of TB elimination in Hainan Province.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-024-01188-2.

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Most cited references 42

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Global Tuberculosis Report 2020 – Reflections on the Global TB burden, treatment and prevention efforts

Jeremiah Chakaya, Mishal Khan, Francine Ntoumi … (2021)

The October 2020 Global TB report reviews TB control strategies and United Nations (UN) targets set in the political declaration at the September 2018 UN General Assembly high-level meeting on TB held in New York. Progress in TB care and prevention has been very slow. In 2019, TB remained the most common cause of death from a single infectious pathogen. Globally, an estimated 10.0 million people developed TB disease in 2019, and there were an estimated 1.2 million TB deaths among HIV-negative people and an additional 208, 000 deaths among people living with HIV. Adults accounted for 88% and children for 12% of people with TB. The WHO regions of South-East Asia (44%), Africa (25%), and the Western Pacific (18%) had the most people with TB. Eight countries accounted for two thirds of the global total: India (26%), Indonesia (8.5%), China (8.4%), the Philippines (6.0%), Pakistan (5.7%), Nigeria (4.4%), Bangladesh (3.6%) and South Africa (3.6%). Only 30% of the 3.5 million five-year target for children treated for TB was met. Major advances have been development of new all oral regimens for MDRTB and new regimens for preventive therapy. In 2020, the COVID-19 pandemic dislodged TB from the top infectious disease cause of mortality globally. Notably, global TB control efforts were not on track even before the advent of the COVID-19 pandemic. Many challenges remain to improve sub-optimal TB treatment and prevention services. Tuberculosis screening and diagnostic test services need to be ramped up. The major drivers of TB remain undernutrition, poverty, diabetes, tobacco smoking, and household air pollution and these need be addressed to achieve the WHO 2035 TB care and prevention targets. National programs need to include interventions for post-tuberculosis holistic wellbeing. From first detection of COVID-19 global coordination and political will with huge financial investments have led to the development of effective vaccines against SARS-CoV2 infection. The world now needs to similarly focus on development of new vaccines for TB utilizing new technological methods.

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Tuberculosis prevalence in China, 1990-2010; a longitudinal analysis of national survey data.

Lixia Wang, Hui Zhang, Yunzhou Ruan … (2014)

China scaled up a tuberculosis control programme (based on the directly observed treatment, short-course [DOTS] strategy) to cover half the population during the 1990s, and to the entire population after 2000. We assessed the effect of the programme. In this longitudinal analysis, we compared data from three national tuberculosis prevalence surveys done in 1990, 2000, and 2010. The 2010 survey screened 252,940 eligible individuals aged 15 years and older at 176 investigation points, chosen by stratified random sampling from all 31 mainland provinces. All individuals had chest radiographs taken. Those with abnormal radiographs, persistent cough, or both, were classified as having suspected tuberculosis. Tuberculosis was diagnosed by chest radiograph, sputum-smear microscopy, and culture. Trained staff interviewed each patient with tuberculosis. The 1990 and 2000 surveys were reanalysed and compared with the 2010 survey. From 1990 to 2010, the prevalence of smear-positive tuberculosis decreased from 170 cases (95% CI 166-174) to 59 cases (49-72) per 100,000 population. During the 1990s, smear-positive prevalence fell only in the provinces with the DOTS programme; after 2000, prevalence decreased in all provinces. The percentage reduction in smear-positive prevalence was greater for the decade after 2000 than the decade before (57% vs 19%; p<0.0001). 70% of the total reduction in smear-positive prevalence (78 of 111 cases per 100,000 population) occurred after 2000. Of these cases, 68 (87%) were in known cases-ie, cases diagnosed with tuberculosis before the survey. Of the known cases, the proportion treated by the public health system (using the DOTS strategy) increased from 59 (15%) of 370 cases in 2000 to 79 (66%) of 123 cases in 2010, contributing to reduced proportions of treatment default (from 163 [43%] of 370 cases to 35 [22%] of 123 cases) and retreatment cases (from 312 [84%] of 374 cases to 48 [31%] of 137 cases; both p<0.0001). In 20 years, China more than halved its tuberculosis prevalence. Marked improvement in tuberculosis treatment, driven by a major shift in treatment from hospitals to the public health centres (that implemented the DOTS strategy) was largely responsible for this epidemiological effect. Chinese Ministry of Health. Copyright © 2014 Elsevier Ltd. All rights reserved.

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Geographically and temporally weighted regression for modeling spatio-temporal variation in house prices

Bo Huang, Bo Wu, Michael Barry (2010)

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Author and article information

Contributors

Dapeng Yin: yindapeng@hainan.gov.cn

Xiujun Li:

ORCID: http://orcid.org/0000-0001-7771-2725

xjli@sdu.edu.cn

Shixue Li: shixueli@sdu.edu.cn

Journal

Journal ID (nlm-ta): Infect Dis Poverty

Journal ID (iso-abbrev): Infect Dis Poverty

Title: Infectious Diseases of Poverty

Publisher: BioMed Central (London )

ISSN (Print): 2095-5162

ISSN (Electronic): 2049-9957

Publication date (Electronic): 27 February 2024

Publication date PMC-release: 27 February 2024

Publication date Collection: 2024

Volume: 13

Electronic Location Identifier: 20

Affiliations

[1 ]Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, ( https://ror.org/0207yh398) 44# Wenhuaxi Road, Lixia District, Jinan, Shandong 250012 People’s Republic of China

[2 ]National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, ( https://ror.org/04wktzw65) Beijing, People’s Republic of China

[3 ]GRID grid.24696.3f, ISNI 0000 0004 0369 153X, Clinical Center On TB Control, Beijing Chest Hospital, , Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, ; Beijing, People’s Republic of China

[4 ]Hainan Center for Disease Control and Prevention, ( https://ror.org/02yr91f43) Haikou, Hainan 570203 People’s Republic of China

[5 ]Research Center for Tuberculosis Control, Shandong University, ( https://ror.org/0207yh398) Jinan, Shandong People’s Republic of China

Author information

Xiujun Li http://orcid.org/0000-0001-7771-2725

Article

Publisher ID: 1188

DOI: 10.1186/s40249-024-01188-2

PMC ID: 10898115

PubMed ID: 38414000

SO-VID: 2f9c4dde-d3e7-42be-8582-12b92d96c3d2

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Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 18 October 2023

Date accepted : 6 February 2024

Funding

Funded by: Talent Development Plan for High-level Public Health Technical Personnel Project of Beijing Municipal Health Commission

Award ID: 2022-2-010

Award Recipient : Jian Du

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Keywords: tuberculosis,elimination,hainan province china,epidemiological characteristics,geographically,temporally weighted regression

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Keywords: tuberculosis, elimination, hainan province china, epidemiological characteristics, geographically, temporally weighted regression

Toward tuberculosis elimination by understanding epidemiologic characteristics and risk factors in Hainan Province, China

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Point-Of-Care Testing for Tuberculosis

Most cited references 42

Global Tuberculosis Report 2020 – Reflections on the Global TB burden, treatment and prevention efforts

Tuberculosis prevalence in China, 1990-2010; a longitudinal analysis of national survey data.

Geographically and temporally weighted regression for modeling spatio-temporal variation in house prices

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