Epidemiological characteristics of tuberculosis incidence and its macro-influence factors in Chinese mainland during 2014-2021

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.

Epidemiological characteristics of imported respiratory infectious diseases in China,2014-2018

Background:With the progress of globalization,international mobility increases,greatly facilitating cross-border transmission of respiratory infectious diseases(RIDs).This study aimed to analyze the epidemiological characteristics and factors influencing imported RIDs,with the goal of providing evidence to support adoption of high-tech,intel-ligent methods to early find imported RIDs and prevent their spread in China.Methods:We obtained data of imported RIDs cases from 2014 to 2018 from the Inbound Sentinel Network of Customs and the National Notifiable Diseases Reporting System in China.We analyzed spatial,temporal,and population distribution characteristics of the imported RIDs.We developed an index to describe seasonality.Pearson correlation coefficients were used to examine associations between independent variables and imported cases.Data analyses and visualizations were conducted with R software.Results:From a total of 1409265253 inbound travelers,31732(2.25/100000)imported RIDs cases were reported.RIDs cases were imported from 142 countries and five continents.The incidence of imported RIDs was nearly 5 times higher in 2018(2.81/100000)than in 2014(0.58/100000).Among foreigners,incidence rates were higher among males(5.32/100000),0–14-year-olds(15.15/100000),and cases originating in Oceania(11.10/100000).The vast majority(90.3%)of imported RIDs were influenza,with seasonality consistent with annual seasonality of influenza.The spatial distribution of imported RIDs was different between Chinese citizens and foreigners.Increases in inbound travel volume and the number of influenza cases in source countries were associated with the number of imported RIDs.Conclusions:Our study documented importation of RIDs into China from 142 countries.Inbound travel poses a significant risks bringing important RIDs to China.It is urgent to strengthen surveillance at customs of inbound travelers and establish an intelligent surveillance and early warning system to prevent importation of RIDs to China for preventing further spread within China.