Abstract
IntroductionTuberculosis is one of the main infectious diseases threatening global health, which is also the main cause of death from a single source of infection (above HIV/AIDS). China is a country with a high burden of tuberculosis in the world, ranking only behind India and Indonesia. However, there are few ecological studies on the burden of tuberculosis in China. This study aims to provide more research basis for the government to formulate tuberculosis policies by exploring the ecological factors associated with the incidence of tuberculosis, so as to achieve the goal of eliminating tuberculosis by 2030.MethodsWe collected data on the incidence of tuberculosis and ecological factors of 31 provinces, autonomous regions, and municipalities in Mainland China (excluding Taiwan, Hong Kong, and Macau) from 2002 to 2018. We constructed a framework of ecological factors affecting the incidence, which consists of 5 secondary indicators and 35 tertiary indicators. And we construct a dynamic panel data model based on the Lasso Regression to select variables to test the effect of each ecological factor on the incidence.ResultsAmong the 35 tertiary indicators, economy 3,4,6,7, environment 1, recourses 1,3, demography 3, and lifecare 2,4,8,9,13 passed the significance test at the 1% level, economy 1,2,5, environment 2,9, lifecare 6,12 passed the significance test at the 5% level, lifecare 10 passed the significance test at the 10% level. Only economy 5 and economy 6 have a positive impact on the incidence, other statistically significant ecological indicators are negatively correlated with the incidence.ConclusionsOur study indicated that many ecological factors, including residents' income, unemployment rate, educational level, medical resources, population density, sunshine duration and dietary structure, are closely related to the incidence of tuberculosis. These findings contribute the government to taking targeted measures for tuberculosis prevention and control, including improving the level of economic development, increasing employment, expanding the scale of enrollment in colleges and universities, and ensuring that the prices of sources of animal protein are reasonable to meet the residents' intake of protein.
Highlights
Tuberculosis is one of the main infectious diseases threatening global health, which is the main cause of death from a single source of infection
The purpose of this study is to identify ecological factors associated with the incidence of tuberculosis through correlation analysis, so as to fulfill the task of preventing and treating TB better
According to the data in China Statistical Yearbook, we have retained the indicators that can be found in the statistical yearbook and excluded indicators that are not recorded in the statistical yearbook
Summary
Tuberculosis is one of the main infectious diseases threatening global health, which is the main cause of death from a single source of infection (above HIV/AIDS). In the 1990s, the government implemented two major tuberculosis control projects, including the implementation of the directly observed treatment of short course strategy (DOTS) in 13 provinces from 1992 to 2001 and the use of limited funds from the Ministry of Health to fund treatment of an additional 10–15% of the population. These measures have significantly reduced the prevalence and mortality of tuberculosis in China [6, 7]. In order to achieve the SDG target to end the tuberculosis epidemic by 2030, robust assessments of tuberculosis incidence are essential for making polices
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