Analyzing factors affecting tuberculosis incidence in various mainland Chinese economic regions and predicting trends: a comprehensive regression study.

backgroundThe tuberculosis (TB) burden differs significantly across various regions of China, and these differences influence the effort focused on eradicating TB nationwide. The main factors influencing variations in TB incidence rates between different regions remain unclear. Therefore, the aim of this study was to analyze the factors influencing TB rates in different economic regions of China as well as determine the actual TB incidence rates during the COVID-19 pandemic and to project 2025 rates.

methodsThis study was based on the surveillance data of TB incidence from the Chinese Center for Disease Control and Prevention. Joinpoint regression analysis was employed to analyze the temporal trends of the TB incidence rate, and a generalized additive model was used to analyze the influencing factors and their differences in distribution in China and different economic zones. The machine learning models were used to determine the actual incidence of TB in China during the COVID-19 pandemic and forecast the incidence rate up to 2025.

resultsFrom 2004 to 2020, the incidence rate of TB increased in all areas, except for Xizang. Other provinces in China showed a downward trend, and the inflection point of the decline appeared near 2008. Western China had a notably higher incidence rate than other regions. The number of medical and health institutions, the number of health personnel, and gross domestic product per capita were negatively correlated with the incidence rate, especially in the western region. The seasonal autoregressive integrated moving average model achieved the optimal fit. Through this model, the following predictions were made: the incidence of TB in central, western, northeastern, and eastern China will be 52.460/100,000, 81.438/100,000, 59.152/100,000, and 52.401/100,000, respectively, with all incidence rates higher than the TB incidence rates reported during COVID-19 pandemic in 2020.

conclusionExcept in the eastern region, China is unlikely to achieve its 2025 goals. Regional economic disparities coupled with strained medical resources during the COVID-19 crisis have hindered TB control efforts. To address this issue, it is recommended that the central and western regions prioritize optimizing health resource allocation and strengthening the management of patients with TB.