The Environmental and Socioeconomic Effects and Prediction of Patients With Tuberculosis in Different Age Groups in Southwest China: A Population-Based Study

BACKGROUND: While the End Tuberculosis (TB) Strategy has been implemented worldwide, the cause of the TB epidemic is multifactorial and not fully understood. OBJECTIVE: This study aims to investigate the risk factors of TB and incorporate these factors to forecast the incidence of TB infection across different age groups in Sichuan, China. METHODS: Correlation and linear regression analyses were conducted to assess the relationships between TB cases and ecological factors, including environmental, economic, and social factors, in Sichuan Province from 2006 to 2017. The transfer function-noise model was used to forecast trends, considering both time and multifactor effects. RESULTS: From 2006 to 2017, Sichuan Province had a reported cumulative incidence rate of 1321.08 cases per 100,000 individuals in male patients and 583.04 cases per 100,000 individuals in female patients. There were significant sex differences in the distribution of cases among age groups (trend χ(2)(25)=12,544.4; P<.001). Ganzi Tibetan Autonomous Prefecture had the highest incidence rates of TB in both male and female patients in Sichuan. Correlation and regression analyses showed that the total illiteracy rate and average pressure at each measuring station (for individuals aged 15-24 years) were risk factors for TB. The protective factors were as follows: the number of families with the minimum living standard guarantee in urban areas, the average wind speed, the number of discharged patients with invasive TB, the number of people with the minimum living standard guarantee in rural areas, the total health expenditure as a percentage of regional gross domestic product, and being a single male individual (for those aged 0-14 years); the number of hospitals and number of health workers in infectious disease hospitals (for individuals aged 25-64 years); and the amount of daily morning and evening exercise, the number of people with the urban minimum living standard guarantee, and being married (for female individuals aged ≥65 years). The transfer function-noise model indicated that the incidence of TB in male patients aged 0-14 and 15-24 years will continue to increase, and the incidence of TB in female patients aged 0-14 and ≥65 years will continue to increase rapidly in Sichuan by 2035. CONCLUSIONS: The End TB Strategy in Sichuan should consider environmental, educational, medical, social, personal, and other conditions, and further substantial efforts are needed especially for male patients aged 0-24 years, female patients aged 0-14 years, and female patients older than 64 years.