Abstract
BackgroundHuman migration facilitate the spread of tuberculosis (TB). Migrants face an increased risk of TB infection. In this study, we aim to explore the spatial inequity of sputum smear-positive pulmonary TB (SS + PTB) in China; and the spatial heterogeneity between SS + PTB and internal migration.MethodsNotified SS + PTB cases in 31 provinces in mainland China were obtained from the national web-based PTB surveillance system database. Internal migrant data were extracted from the report on China’s migrant population development. Spatial autocorrelations were explored using the global Moran’s statistic and local indicators of spatial association. The spatial variation in temporal trends was performed using Kulldorff’s scan statistic. Fixed effect and spatial autoregressive models were used to explore the spatial inequity between SS + PTB and internal migration.ResultsA total of 2 380 233 SS + PTB cases were reported in China between 2011 and 2017, of which, 1 716 382 (72.11%) were male and 663 851 (27.89%) were female. Over 70% of internal migrants were from rural households and had lower income and less education. The spatial variation in temporal trend results showed that there was an 9.9% average annual decrease in the notification rate of SS + PTB from 2011 to 2017; and spatial clustering of SS + PTB cases was mainly located in western and southern China. The spatial autocorrelation results revealed spatial clustering of internal migration each year (2011–2017), and the clusters were stable within most provinces. Internal emigration, urban-to-rural migration and GDP per capita were significantly associated with SS + PTB, further, internal emigration could explain more variation in SS + PTB in the eastern region in mainland. However, internal immigration and rural-to-urban migration were not significantly associated with SS + PTB across China.ConclusionsOur study found the spatial inequity between SS + PTB and internal migration. Internal emigration, urban-to-rural migration and GDP per capita were statistically associated with SS + PTB; the negative association was identified between internal emigration, urban-to-rural migration and SS + PTB. Further, we found those migrants with lower income and less education, and most of them were from rural households. These findings can help stakeholders to implement effective PTB control strategies for areas at high risk of PTB and those with high rates of internal migration.
Highlights
Human migration facilitate the spread of tuberculosis (TB)
Among the total sample of internal migrants, 51.19% of whom were migrated across provinces and 30.73% migrated across municipal jurisdictions within a province
We found spatial inequity of SS + Sputum smear-positive pulmonary TB (PTB) and spatial variation in internal migration in mainland China
Summary
Human migration facilitate the spread of tuberculosis (TB). Migrants face an increased risk of TB infec‐ tion. The World Health Organization (WHO) estimated that 10.4 million people developed TB and there were more than 1.7 million TB He et al Infect Dis Poverty (2020) 9:159 deaths worldwide in 2016 [3]. Over the past two decades, China has made great progress in controlling TB; the prevalence of smear-positive TB cases has declined by 65% with the implementation of a nationalscale control programme to tackle TB problems [5]. Despite this progress, there is still nearly one million newly confirmed cases annually. There is spatial inequality in the prevalence of TB between the east, central, and western regions of China [6]
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