Abstract
BackgroundPrevious research pointed to a close relationship between the incidence of tuberculosis (TB) in aging populations and socio-economic conditions, however there has been lack of studies focused on a region of unbalanced socio-economic development. The aim of this paper is to explore the spatio-temporal variation in TB incidence and examine risk determinants of the disease among aging populations in a typical region.MethodsData on TB-registered cases between 2009 and 2014, in addition to social-economic factors, were collected for each district/county in Beijing, Tianjin and Hebei, a region characterized by an aging population and disparities in social-economic development. A Bayesian space–time hierarchy model (BSTHM) was used to reveal spatio-temporal variation in the incidence of TB among the elderly in this region between 2009 to 2014. GeoDetector was applied to measure the determinant power (q statistic) of risk factors for TB among the elderly.ResultsThe incidence of TB among the elderly exhibited geographical spatial heterogeneity, with a higher incidence in underdeveloped rural areas compared with that in urban areas. Hotspots of TB incidence risk among the elderly were mostly located in north-eastern and southern areas in the study region, far from metropolitan areas. Areas with low risk were distributed mainly in the Beijing-Tianjin metropolitan areas. Social-economic factors had a non-linear influence on elderly TB incidence, with the dominant factors among rural populations being income (q = 0.20) and medical conditions (q = 0.17). These factors had a non-linear interactive effect on the incidence of TB among the elderly, with medical conditions and the level of economic development having the strongest effect (q = 0.54).ConclusionsThe findings explain spatio-temporal variation in TB incidence and risk determinants of elderly TB in the presence of disparities in social-economic development. High-risk zones were located mainly in rural areas, far from metropolitan centres. Medical conditions and the economic development level were significantly associated with elderly TB incidence, and these factors had a non-linear interactive effect on elderly TB incidence. The findings can help to optimize the allocation of health resources and to control TB transmission in the aging population in this region.
Highlights
Previous research pointed to a close relationship between the incidence of tuberculosis (TB) in aging populations and socio-economic conditions, there has been lack of studies focused on a region of unbalanced socio-economic development
Medical conditions and the economic development level were significantly associated with elderly TB incidence, and these factors had a non-linear interactive effect on elderly TB incidence
New TB cases yit in county i and year t were represented as a Poisson distribution, the mathematical expectation of TB case was expressed as the produce between population and the relative risk (RR) of elderly TB incidence: yit $ PossionðnitritÞ
Summary
Previous research pointed to a close relationship between the incidence of tuberculosis (TB) in aging populations and socio-economic conditions, there has been lack of studies focused on a region of unbalanced socio-economic development. The aim of this paper is to explore the spatio-temporal variation in TB incidence and examine risk determinants of the disease among aging populations in a typical region. Tuberculosis (TB) is an airborne infectious disease caused by the Mycobacterium tuberculosis complex; only pulmonary TB is contagious [1]. It is a serious and persistent infectious disease worldwide, which poses a threat to human health, resulting in approximately 10 million illnesses every year [2]. According to World Health Organization (WHO) report, TB is ranked as one of the top 10 leading causes of death from a single infectious agent worldwide [3]. TB remains a major public health problem in China, where there are nearly 830,000 new cases each year [3]
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