Abstract:

Objective: With investigating the spatial-temporal dynamic distribution of pulmonary tuberculosis (PTB) incidence in Xiamen City, Fujian Province from 2014 to 2023, and analyzing the precipitation associated with spatiotemporal clustering, to provide a scientific basis for optimizing the strategies for tuberculosis prevention and control. Methods: This retrospective study employed spatial epidemiological methods to analyze the spatiotemporal clustering patterns of PTB in Xiamen from January 1, 2014 to December 31, 2023. A total of 20207 reported PTB (including tuberculous pleurisy) cases were collected through the China Information System for Disease Control and Prevention. The monthly and yearly precipitation data were collected from Loess Plateau Branch of National Earth System Science Data Center, National Science and Technology Infrastructure. The Chi-square trend test and Mann-Kendall trend test were respectively applied to analyze the trend of annual incidence and precipitation. With the retrospective discrete Poisson spatiotemporal scanning statistics, the spatiotemporal dynamics of PTB incidence was analyzed.With the Chi-square test and binary logistic regression analysis, the monthly precipitation in the scanned cluster/non-cluster areas was analyzed to identify the influencing factors.Statistical significance was set as α=0.05. Results: The average annual PTB incidence rate was 40.78 cases per 100000 population (20207/4955600) in Xiamen from 2014 to 2023, showing a generally fluctuating downward trend ($\chi_{\text {trend }}^2$=253.000,P<0.001); From 2014 to 2023, the spatiotemporal scanning statistics scanned 6 significant clusters, covering 3 districts.Both the Level 1 and Level 2 clusters were in Jimei District.The clustering occurred from June 2017 to September 2019 (RR=1.52, P<0.001), with an average annual incidence of 60.68/100000 population (1375/2265917) and from March 2014 to September 2016 (RR=1.33, P<0.001), with an average annual incidence of 53.44/100000 population (1156/2163167), respectively. A positive correlation was observed between monthly precipitation and the clustering of reported PTB incidence (χ²=5.829,P=0.016). For every 10 mm increase in precipitation, the risk of clustering of reported PTB incidence increased by 2.9% (OR=1.029,95%CI:1.003-1.055). Conclusion: The spatiotemporal clustering of PTB in Xiamen has decreased,and precipitation was identified as a factor influencing the clustering of reported PTB incidence in Xiamen.

Key words: Tuberculosis,pulmonary, Epidemiologic Study, Space-time clustering, Rain, Regression analysis