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From 2005 to 2020, a total of 16.2 million PTB cases were reported, with an average reported incidence of 75.5 per 100,000 population, and the notified incidence declined by 55% from 2005 (1.4 million cases, 108.3 per 100,000 population) to 2020 (0.7 million cases, 49.2 per 100,000 population). The average ASR is per 100,000 individuals. The ASR was the highest in 2005 (116.9 per 100,000 population) and the lowest in 2020 (47.6 per 100,000 population), with a slower rate of decline after 2011 (Figure 2A).
Figure 2. Changes in the notified incidence of PTB rate in China. (A) overall; (B) female vs. male; (C) 4 age groups: (D) urban vs. rural; (E) 7 geographic areas.
Joinpoint regression analysis showed that the reported incidence rate of TB in China decreased by 5.6% annually from 2005 to 2020 (APC = −5.6, 95% CI: −7.0 to −4.2), showing different trends in four periods. The largest changes occurred in 2018. (Table 1 and Supplementary Figure S1, available in www.besjournal.com). Segment analysis showed a 5.1% decline from 2005 to 2008 (APC = −5.1, 95% CI: −7.9 to −2.2), a larger decline occurred in 2008–2011 (APC = −8.6, 95% CI: −14.5 to −2.4), the smallest decline occurred in 2011–2018 (APC = −3.4, 95% CI: −4.6 to −2.3), and the largest decline occurred in 2018–2020 (APC = −9.2, 95% CI: −16.4 to −1.3).
Characteristics Year Notification rates of PTB cases# Annual percent change (95% CI) AAPC (95% CI) Overall 2005–2008 108.3–94.6 −5.1* (−7.9, −2.2) −5.6* (−7.0, −4.2) 2008–2011 94.6–75.6 −8.6* (−14.5, −2.4) 2011–2018 75.6–61.6 −3.4* (−4.6, −2.3) 2018–2020 61.6–49.2 −9.2* (−16.4, −1.3) Sex Female 2005–2011 67.7–46.7 −6.5* (−7.8, −5.3) −4.9* (−5.5, −4.2) 2011–2020 46.7–31.8 −3.7* (−4.6, −2.9) Male 2005–2013 146.6–93.9 −6.7* (−7.5, −5.9) −6.0* (−7.3, −4.7) 2013–2018 93.9–82.9 −3.0* (−5.5, −0.3) 2018–2020 82.9–65.9 −10.6* (−18.8, −1.5) Age group 0–14 2005–2010 10.8–3.9 −17.4* (−18.6, −16.1) −7.3* (−8.6, −6.0) 2010–2014 3.9–3.0 −9.1* (−13.8, −4.0) 2014–2020 3.0–3.5 3.3* (1.4, 5.2) 15–34 2005–2015 101.3–61.6 −4.9* (−5.4, −4.4) −4.2* (−4.8, −3.6) 2015–2020 61.6–51.8 −2.6* (−4.5, −0.8) 35–64 2005–2011 125.4–83.0 −6.5* (−7.5, −5.5) −5.8* (−6.8, −4.7) 2011–2018 83.0–67.8 −3.0* (−4.2, −1.9) 2018–2020 67.8–50.4 −12.7* (−19.4, −5.3) ≥ 65 2005–2011 280.6–166.3 −7.3* (−9.9, −4.5) −6.4* (−9.2, −3.5) 2011–2020 166.3–101.4 −4.9* (−6.5, −3.2) Rural or urban Rural 2005–2010 100.9–75.3 −6.1* (−7.4, −4.9) −4.5* (−5.5, −3.5) 2010–2018 75.3–71.8 −2.1* (−3.1, −1.2) 2018–2020 71.8–56.3 −9.6* (−16.7, −1.9) Urban 2005–2008 117.3–100.1 −4.9* (−8.3, −1.4) −6.3* (−7.7, −4.9) 2008−2011 100.1−74.2 −10.8* (−17.5, −3.6) 2011−2020 74.2−44.8 −5.3* (−6.0, −4.5) Region Central China 2005−2010 122.9−84.4 −7.4* (−9.2, −5.5) −5.2* (−6, −4.5) 2010−2020 84.4−57.4 −4.1* (−4.9, −3.3) East China 2005−2011 86.5−54.5 −8.2* (−9.1, −7.3) −6.1* (−6.5, −5.6) 2011−2020 54.5−36.4 −4.6* (−5.3, −4) North China 2005−2008 79.6−72.0 −4.0* (−7.7, −0.1) −5.9* (−6.9, −4.8) 2008−2014 72.0−46.0 −8.0* (−9.8, −6.1) 2014−2020 46.0−32.6 −4.6* (−6.3, −2.9) Northeast 2005−2018 89.3−53.0 −4.6* (−5, −4.3) −6.2* (−7.3, −5.1) 2018−2020 53.0−37.4 −15.8* (−23.4, −7.4) Northwest 2005−2014 124.7−90.3 −6.3* (−8, −4.6) −6.4* (−10, −2.7) 2014−2018 90.3−113.2 5.2 (−5.5,17) 2018−2020 113.2−58.7 −26.4* (−42.9, −5.1) South China 2005−2020 136.3−60.3 −5.9* (−6.5, −5.3) −5.9* (−6.5, −5.3) Southwest 2005−2011 132.6−93.4 −6.6* (−8.6, −4.7) −4.5* (−5.5, −3.5) 2011−2020 93.4−70.1 −3.0* (−4.3, −1.8) Note. #Per 100,000 people notified in the first and last years of the segment. *Indicates that APCs (annual percentage change) and AAPCs (average annual percentage change) are significantly different from 0 at an alpha level of 0.05. PTB: pulmonary tuberculosis. Table 1. Joinpoint regression analysis results of notified incidence of PTB in China
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The ASR of males was perennially higher than that of females, with an average of 104.6 (/100,000) and 48.8 (/100,000), respectively (Figure 2B). From 2005 to 2020, the average annual percentage change for males and females decreased by 6.0% and 4.9%, respectively. In 2005, the ASR of males was 159.8 (/100,000), and that of females was 72.0 (/100,000). In 2020, the ASR of males was 62.2 (/100,000), and that of females was 32.3 (/100,000). The decline for males narrowed between 2013 and 2018, with the maximum downtrend between 2018 and 2020 (APC = −10.6, 95% CI: −18.8 to −1.5). The decline for females was the largest between 2005 and 2011 (APC = −6.5, 95% CI: −7.8 to −5.3).
Among the different age groups, the average notification rate was the highest among older adults (65 years and older) (182.3/100,000), followed by middle-aged (35–64 years) (84.1/100,000), young people (15–34 years) (73.3/100,000), and children with the lowest (0–14 years) (4.8/100,000). From 2005 to 2020, the different age groups showed a downward trend, but the changes were noticeable (Table 1, Figure 2C, and Supplementary Figure S2, available in www.besjournal.com). The percentage change for children declined by 7.3% annually, with the most significant decline between 2005 and 2010 (APC = −17.4, 95% CI: −18.6 to −16.1) and a smaller decline from 2010 to 2014. However, it increased significantly by 3.3% between 2014 and 2020 (95% CI: 1.4 to 5.2). For young people, the average annual decline was 4.2%, with the smallest decline between 2015 and 2020 (APC = −2.6, 95% CI: −4.5 to −0.8). For middle-aged adults, the average annual decline was 5.8%, with the smallest decline between 2011 and 2018 and the largest decline between 2018 and 2020 (APC = −12.7, 95% CI: −19.4 to −5.3). For older adults, the average annual decline was 6.4%, with the smallest decline between 2011 and 2020 (APC = −4.9, 95% CI: −6.5 to −3.2).
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The average ASR in rural areas (81.3 per 100,000) is higher than that in urban areas (76.1 per 100,000). From 2005 to 2010, the ASR in urban areas was slightly higher than that in rural areas. After 2011, it was continuously higher in rural areas than in urban areas (Figure 2D). From 2005 to 2020, the ASR in urban and rural areas continued to decline, with average annual decreases of 6.3% and 4.5%, respectively. In urban areas, the decline was the largest from 2008 to 2011 (APC = −10.8, 95% CI: −17.5 to −3.6) and smaller after 2011. In rural areas, the decline was the smallest from 2010 to 2018 and the largest between 2018 and 2020 (APC = −9.6, 95% CI: −16.7 to −1.9).
The average ASRs of the seven geographical regions ranged from high to low, as follows: South (103.2/100,000), Northwest (100.1/100,000), Southwest (95.3/100,000), Central (85.9/100,000), Northeast (67.4/100,000), East (57.9/100,000), and North China (56.5/100,000). South, Northwest, and Southwest China were perennially higher, while the East and North China were perennially the lowest (Figure 2E). From 2005 to 2020, all seven regions showed a downward trend with distinct changes during different periods (Table 1). The northwestern region had the maximum overall decline (AAPC = −6.4, 95% CI: −10.0 to −2.7), with a 26.4% decline from 2018 to 2020. The average annual fall was 6.2% (95% CI: −7.3 to −5.1) in the northeast region, with a maximum decline from 2018 to 2020. In East China, the average annual fall rate was 6.1% (95% CI: −6.5 to −5.6), with the most significant decline from 2005 to 2011. In North China, the average annual decline was 5.9% (95% CI: −6.9 to −4.8), with a maximum decline between 2008 and 2014. In South and Central China, the average annual decline was 5.9% (95% CI: −6.8 to −5.3) and 5.2% (95% CI: −6.0 to −4.5), respectively. The lowest annual decline was in the southwest (AAPC = −4.5, 95% CI: −5.5 to −3.5), dropping only 3.0% between 2011 and 2020.
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Changes in Notified PTB Incidence Nationwide
Changes in Notified Incidence of PTB in Different Sex and Age Groups
Changes in Notified Incidence of PTB in Urban/Rural Areas and Seven Geographical Regions
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