Geographical evolutionary pathway of global tuberculosis incidence trends

Abstract

Backgrounds: Tuberculosis (TB) remains a serious public health and human development problem, especially in developing countries. Despite the effectiveness of directly observed therapy, short course programs in reducing transmission and progression of TB, poverty reduction and socioeconomic development remain crucial factors in decreasing TB incidence. However, the geographical pathway on the planet is not yet clear.

Objectives: This study was to reconstruct the geographical evolutionary process of TB in 173 countries and territories from 2010 to 2019 to analyze the socioeconomic determinants that impact the global TB epidemic. In addition, the TB incidence in 2030 was predicted.

Methods: This study analyses TB incidence data from 173 countries and territories between 2010 and 2019. The Geotree model would be used to reconstruct the geographical evolutionary process of TB, which provides a simplified schema for geo-visualizing the trajectories of TB incidence and their socioeconomic drivers. Additionally, to estimate the future TB incidence in 2030, a multilevel model was utilized in conjunction with the hierarchical nature of the Geotree based on a stratified heterogeneity analysis.

Results: Global TB incidence was found to be associated with the country type and development stages. Between 2010 and 2019, the average TB incidence rate in 173 countries and territories was -27.48%, with marked spatially stratified heterogeneity by country type and development stage. Low-income and lower-middle-income countries were most vulnerable to TB. Upper-middle-income countries experienced a faster decline in TB incidence than high-income countries, and TB incidence generally decreased as the development stage increased, except for the lower-middle development stage in 2019.The highest average rate of decline in TB incidence was observed in the upper-middle development stage of high-income countries, with a reduction of 45.24%. Meanwhile, 37 high-income countries in the high development stage demonstrated an average rate of change of -13.93%. Socioeconomic determinants, including gross domestic product per capita, urbanization rate, and sociodemographic index, were found to inhibit TB incidence. Based on current trends, the predicted average global TB incidence in 2030 is 91.581 per 100,000 population.

Conclusions: The trajectories of the global TB incidence have been reconstructed to formulate targeted public health responses. To eliminate TB, countries at similar development stage can draw on the experiences of countries at higher development stages that are tailored to their unique characteristics. By learning from successful TB control strategies, countries can take strategic steps toward eradicating TB and improving public health outcomes.

Keywords: Geographical evolutionary pathway; Geotree; Stratified heterogeneity; Tuberculosis.

Fig. 1

The TB incidence rate (per 100,000 population) Geotrees corresponding to the geospatial distributions in 2010 (A) and in 2019 (B) in 173 countries and territories

Fig. 2

Average incidence of TB (per 100,000 population) in 2010 and 2019 for the four country types

Fig. 3

Average rate of change in the TB incidence (%) in 173 countries and territories from 2010 to 2019 for the four country types. Note: The countries in each country types are listed in Supplementary file 1. Table S1

Fig. 4

Average incidence of TB (per 100,000 population) in 2010 (A) and 2019 (B)for the five country development stages

Fig. 5

Average rate of change in the TB incidence (%) from 2010 to 2019 in 173 countries and territories based on the country development stage. Note: The countries in each development stages are listed in Supplementary file 1. Table S3 and Supplementary file 1. Table S4

Fig. 6

Evolutionary pathway of the country development stage by Markov chain analysis. Note: Each arrow represents a transition type, for which the tail and head of the arrow indicate the initial and final development stage levels, respectively. For each country type, the areas with the same initial and final country development stage are classified into one category for the statistical analysis, statistical data in the form of probability. The number of countries for which the development stage changed and the average rate of change in the TB incidence are shown in brackets near the arrow

Fig. 7

Prediction of the spatial TB incidence in 173 countries and territories in 2030