ArticlePloS one2013
Tuberculosis incidence correlates with sunshine: an ecological 28-year time series study.
Article in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 2 of them syntheses that pooled it.
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Who cites it
53 citing papers in PubMed, 2 syntheses or guidelines pooled it, 120 citations in OpenAlex.
- Vitamin D and the risk of latent tuberculosis infection: a systematic review and meta-analysis.BMC pulmonary medicine · 2022Pooled it
- Drivers of Seasonal Variation in Tuberculosis Incidence: Insights from a Systematic Review and Mathematical Model.Epidemiology (Cambridge, Mass.) · 2018Pooled it
- Data-driven model analysis of the impact of environmental and socioeconomic factors on tuberculosis incidence.Infectious Disease Modelling · 2026Article
- Article
- Geospatial analysis of tuberculosis incidence in relation to socio-economic and environmental indicators in Romania.Frontiers in public health · 2025Article
- Changes in incidence and clinical features of tuberculosis with regard to the COVID-19 outbreak in Southern Iran.BMC infectious diseases · 2024Article
- Predicting the incidence of rifampicin resistant tuberculosis in Yunnan, China: a seasonal time series analysis based on routine surveillance data.BMC infectious diseases · 2024Article
- The impact of meteorological factors on tuberculosis incidence in Spain: a spatiotemporal analysis.Epidemiology and infection · 2024Article
- Spatio-Temporal Pattern of Tuberculosis Distribution in Romania and Particulate Matter Pollution Associated With Risk of Infection.GeoHealth · 2024Article
- Role of meteorological parameters with the spread of Covid-19 in Pakistan: application of autoregressive distributed lag approach.International journal of environmental science and technology : IJEST · 2023Article
- The incidence of tuberculous pleurisy in mainland China from 2005 to 2018.Frontiers in public health · 2023Article
- Epidemiological Characteristics and Spatial-Temporal Analysis of Tuberculosis at the County-Level in Shandong Province, China, 2016-2020.Tropical medicine and infectious disease · 2022Article
- Article
- Association between climate variables and pulmonary tuberculosis incidence in Brunei Darussalam.Scientific reports · 2022Article
- Short-term effects of ambient air pollution and meteorological factors on tuberculosis in semi-arid area, northwest China: a case study in Lanzhou.Environmental science and pollution research international · 2021Article
- HspX-mediated survival pathways of pathogenic mycobacteria.Saudi medical journal · 2021Article
- Spatiotemporal Patterns of Tuberculosis in Hunan Province, China.International journal of environmental research and public health · 2021Article
- An Ecological Study of Tuberculosis Incidence in China, From 2002 to 2018.Frontiers in public health · 2021Article
- Temperature and humidity associated with increases in tuberculosis notifications: a time-series study in Hong Kong.Epidemiology and infection · 2020Article
- The long-term effects of meteorological parameters on pertussis infections in Chongqing, China, 2004-2018.Scientific reports · 2020Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBirmingham is the largest UK city after London, and central Birmingham has an annual tuberculosis incidence of 80 per 100,000. We examined seasonality and sunlight as drivers of tuberculosis incidence. Hours of sunshine are seasonal, sunshine exposure is necessary for the production of vitamin D by the body and vitamin D plays a role in the host response to tuberculosis.
methodsWe performed an ecological study that examined tuberculosis incidence in Birmingham from Dec 1981 to Nov 2009, using publicly-available data from statutory tuberculosis notifications, and related this to the seasons and hours of sunshine (UK Meteorological Office data) using unmeasured component models.
resultsThere were 9,739 tuberculosis cases over the study period. There was strong evidence for seasonality, with notifications being 24.1% higher in summer than winter (p<0.001). Winter dips in sunshine correlated with peaks in tuberculosis incidence six months later (4.7% increase in incidence for each 100 hours decrease in sunshine, p<0.001). DISCUSSION AND
conclusionA potential mechanism for these associations includes decreased vitamin D levels with consequent impaired host defence arising from reduced sunshine exposure in winter. This is the longest time series of any published study and our use of statutory notifications means this data is essentially complete. We cannot, however, exclude the possibility that another factor closely correlated with the seasons, other than sunshine, is responsible. Furthermore, exposure to sunlight depends not only on total hours of sunshine but also on multiple individual factors. Our results should therefore be considered hypothesis-generating. Confirmation of a potential causal relationship between winter vitamin D deficiency and summer peaks in tuberculosis incidence would require a randomized-controlled trial of the effect of vitamin D supplementation on future tuberculosis incidence.
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