Epidemiological characteristics of pulmonary tuberculosis in patients with pneumoconiosis based on its social determinants and risk factors in China: a cross-sectional study from 27 provinces

BACKGROUND: Patients with pneumoconiosis have an elevated risk of contracting pulmonary tuberculosis (PTB) and need particular attention. However, extensive population-based studies on the prevalence of PTB in patients with pneumoconiosis have not been reported in China since 1992. This study aimed to investigate the epidemiological characteristics of PTB in patients with pneumoconiosis based on its social determinants and risk factors in China. METHODS: Based on the Commission on Social Determinants of Health (CSDH) framework, data were obtained from a questionnaire survey of patients with pneumoconiosis from China's 27 provinces (autonomous regions, municipalities) from December 2017 to June 2021. By chi-square and multivariate logistic regression analyses, the epidemiological characteristics of PTB in the patients were identified based on its prevalence and odds ratio (OR) and associated social determinants and risk factors. The population attributable fractions (PAFs) of significant risk factors were also calculated. RESULTS: The prevalence of PTB in patients with pneumoconiosis (n = 10,137) was 7.5% (95% confidence interval [CI]: 7.0–8.0%). Multivariate logistic regression analysis showed that risk factors included in-hospital exposure to patients with PTB (OR = 3.30, 95% CI: 2.77–3.93), clinically diagnosed cases (OR = 3.25, 95% CI: 2.42–4.34), and northeastern regions (OR = 2.41, 95% CI: 1.76–3.31). In addition, lack of work-related injury insurance (WRII), being born in a rural area, being unemployed, living in western regions, household exposure to patients with PTB, smoking, being underweight, complications of pulmonary bullae or pneumothorax, hospitalization history, and former drinkers among the rural patients were also statistically significant risk factors. Being born in a rural area, lack of WRII and in-hospital exposure to patients with PTB had higher PAFs, which were 13.2% (95% CI: 7.9–18.5%), 12.5% (95% CI: 8.3–16.7%), and 11.6% (95% CI: 8.8–14.3%), respectively. CONCLUSION: The prevalence of PTB in pneumoconiosis remains high in China; it is basically in line with the CSDH models and has its characteristics.