Abstract
The aim of the present study was to assess spatial features of tuberculosis prevalence and their relationships with four main ethnic communities in Taiwan. Methods of spatial analysis were clustering pattern determination (such as global version of Moran’s test and local version of Gi*(d) statistic), using logistic regression calculations to identify spatial distributions over a contiguous five years and identify significant similarities, discriminant analysis to classify variables, and geographically weighted regression (GWR) to determine the strength of relationships between tuberculosis prevalence and ethnic variables in spatial features. Tuberculosis demonstrated decreasing trends in prevalence in both genders during 2005 to 2009. All results of the global Moran’s tests indicated spatial heterogeneity and clusters in the plain and mountainous Aboriginal townships. The Gi*(d) statistic calculated z-score outcomes, categorized as clusters or non-clusters, at at 5% significance level. According to the stepwise Wilks’ lambda discriminant analysis, in the Aborigines and Hoklo communities townships with clusters of tuberculosis cases differentiated from townships without cluster cases, to a greater extent than in the other communities. In the GWR models, the explanatory variables demonstrated significant and positive signs of parameter estimates in clusters occurring in plain and mountainous aboriginal townships. The explanatory variables of both the Hoklo and Hakka communities demonstrated significant, but negative, signs of parameter estimates. The Mainlander community did not significantly associate with cluster patterns of tuberculosis in Taiwan. Results indicated that locations of high tuberculosis prevalence closely related to areas containing higher proportions of the Aboriginal community in Taiwan. This information is relevant for assessment of spatial risk factors, which, in turn, can facilitate the planning of the most advantageous types of health care policies, and implementation of effective health care services.
Highlights
Tuberculosis (TB) is one of the world’s principal infectious diseases
The results provided tuberculosis prevalence rates for males and females in the whole of Taiwan and in each township in the study area, and these were applied to spatial autocorrelation analysis
Discriminant analysis is useful for determining which variables discriminate between two or more groups, building a predictive model of group membership based on observed characteristics of each case [27]
Summary
Tuberculosis (TB) is one of the world’s principal infectious diseases. In 2007, the World Health Organization (WHO) estimated that more than nine million new cases of TB occur globally, with more than half of these new cases occurring in Asia (55%). 1.76 million people died of TB worldwide in 2007. With increasing numbers of cases of human immunodeficiency virus (HIV) and multidrug resistant tuberculosis (MDR-TB), prevention of TB has posed a significant challenge. The infectiousness of the person with TB, the susceptibility of those exposed, the duration of exposure, the proximity to the source case, and the efficiency of cabin ventilation are all factors which can influence the risk of infection. Susceptibility to infection and disease increases in immunocompromised persons (such as human immunodeficiency virus-infected persons) and infants and young children (less than five years of age). When TB develops in the human body, it does so in two stages: first, the individual exposed to M. tuberculosis becomes infected, and second, the infected individual develops the disease (active TB).
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