Objective To understand the epidemiological characteristics and changing trend of pulmonary tuberculosis (TB) in Shaanxi province from 2005 to 2024, and provide scientific evidence for the development of targeted prevention and control strategies.
Methods Descriptive epidemiological methods were used to analyze the population, area, and temporal distribution characteristics of pulmonary TB in Shaanxi. Joinpoint regression model (Joinpoint 5.2.0.0) was used to analyze temporal trends and calculate the annual percentage change (APC) and average annual percentage change (AAPC). Global spatial autocorrelation analysis (Global Moran's I) was performed by using R 4.4.2. Seasonal characteristics of pulmonary TB were assessed by using the seasonal index method in R 4.4.2.
Results From 2005 to 2024, a total of 470 518 pulmonary TB cases were reported in Shaanxi. The reported incidence of pulmonary TB decreased from 107.48/100 000 in 2005 to 36.72/100 000 in 2024, a reduction of 65.84% (AAPC=−4.86%, P<0.001). The average annual reported incidence was 61.74/100 000. The bacteriological positive rate increased from 34.38% in 2005 to 67.59% in 2024. Northern Shaanxi had the highest average annual reported incidence of pulmonary TB (75.54/100 000), followed by southern Shaanxi (67.32/100 000), while central Shaanxi had the lowest incidence (57.63/100 000). During 2005−2024, Xi'an had the largest reduction (72.81%) and average annual decline rate (6.30%) in the reported incidence of pulmonary TB, whereas Yan'an had the smallest reduction (43.91%) and average annual decline rate (2.85%). The reported incidence of pulmonary TB showed positive spatial autocorrelation in each year from 2005 to 2024 (Moran's I>0, P<0.001), indicating the existence of spatial clustering. The average annual reported incidence was higher in men (79.39/100 000) than in women (43.02/100 000). The proportion of cases aged ≥60 years increased from 23.74% in 2005 to 44.99% in 2024 (APC=3.02%, 95%CI: 2.28%−3.75%, P<0.001). Farmers were the predominant occupational group, accounting for 64.72% of all the cases. Tuberculosis incidence reports show a seasonal distribution, with relatively higher seasonal indices in January and March to April, with March being the highest.
Conclusion Over the past two decades, the incidence of pulmonary TB showed an overall downward trend in Shaanxi, but area and population specific differences remain evident. Northern and southern Shaanxi, as well as older adults, farmers, school populations, and young adults aged 20～<25 years, should be prioritized for prevention and control. Active screening and targeted interventions should be strengthened to further control the epidemic.
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