Modeling tuberculosis transmission flow in China

Abstract

Abstract Background: China has the third largest number of TB cases in the world, and the average annual floating population in China is more than 200 million, the increasing floating population across regions has a tremendous potential for spreading infectious diseases, however, the role of increasing massive floating population in tuberculosis transmission is yet unclear in China. Methods: 14,027 tuberculosis flow data were derived from the new smear-positive pulmonary tuberculosis cases in China. Spatial interaction model was used to model the tuberculosis flow and the regional socioeconomic factors. Results: Tuberculosis transmission flow presented spatial heterogeneity. The Pearl River Delta in southern China and the Yangtze River Delta along China’s east coast presented as the largest destination and concentration areas of tuberculosis inflows. Socioeconomic factors were determinants of tuberculosis flow. Some impact factors showed different spatial associations with tuberculosis transmission flow. A 10% increase in per capita GDP was associated with 2.1% decrease in tuberculosis outflows from the provinces of origin, and 0.5% increase in tuberculosis inflows to the destinations and 18.9% increase in intraprovincial flow. Per capita net income of rural households and per capita disposable income of urban households were positively associated with tuberculosis flows. A 10% increase in per capita net income corresponded to 3.6% increase in outflows from the origin, 12.8% increase in inflows to the destinations and 47.9% increase in intraprovincial flows. Tuberculosis incidence had positive impacts on tuberculosis flows. A 10% increase in the number of tuberculosis cases corresponded to 1.1% increase in tuberculosis inflows to the destinations, 2.0% increase in outflows from the origins, and 2.2% increase in intraprovincial flows. Conclusions: Tuberculosis flows had clear spatial stratified heterogeneity and spatial autocorrelation, regional socio-economic characteristics had diverse and statistical significant effects on tuberculosis flows in the origin and destination, and income factor played an important role among the determinants.