Effect of proactive detection strategy on risk for underreporting of tuberculosis in Xinjiang Uygur Autonomous Region based on Bayesian hierarchical binary logistic regression modeling

Objective To construct a Bayesian model based on reporting data of tuberculosis (TB) from 14 prefectures in northern and southern Xinjiang Uyghur Autonomous Region(Xinjiang) from 2014 to 2020 in combination with relevant social, economic and environmental factors affecting the report of TB incidence to analyze the impact of proactive detection strategy on the trend of TB underreporting risk in Xinjiang and provide a strong evidence-based support for the subsequent decision making for the precision prevention and control of TB.

Methods The risk factors affecting the TB incidence were collected, and important covariates were screened by using the factor detector in geo-detector method to construct a Bayesian logistic model for the estimation of true incidence of TB and evaluate the changes in the trend of TB underreporting after the implementation of proactive detection strategy in Xinjiang.

Results The factor detector showed that gross domestic product (GDP) per capita was associated with the greatest contribution to the risk for TB underreporting (q=0.668); Bayesian logistic model results showed that the standardized underreporting risk of TB was positively correlated with population density, average annual temperature and average annual sunshine hours, but negatively correlated with annual per capita incomes, the numbers of residents participating in basic medical insurance in both rural area and urban areas. The risk ratio of TB underreporting in Xinjiang showed increase first and then decrease from 2014 to 2020 and the peak was in 2018. The results showed that after the implementation of the proactive discovery strategy from 2018, the registration rate and risk ratio of TB underreporting showed decreasing trends in Xinjiang, and the registration rate and risk ratio of TB underreporting were higher in southern Xinjiang than in northern Xinjiang.

Conclusion After the implementation of the proactive detection strategy, the registration rate and risk ratio of TB underreporting in Xinjiang all showed decreasing trends, indicating the achievement in this field. The risk for TB underreporting was higher in southern Xinjiang than in northern Xinjiang, and it is recommended to focus southern Xinjiang in TB prevention and control, and the implementation of TB prevention and control strategy in southern Xinjiang can provide theoretical basis for further research and practice of TB prevention and control.