Spatiotemporal Patterns and Determinants of Tuberculosis Incidence in China, 2005-2020: Integrating Meteorological and Socioeconomic Perspective

Tuberculosis (TB) is a chronic infectious disease that poses a significant threat to public health in China, which ranks among the top three high-burden countries globally. Examining the socioeconomic, environmental, and other key factors that influence TB incidence can clarify their combined impact on this epidemic. This study systematically analyzes the spatiotemporal patterns and determinants of TB incidence in mainland China from 2005 to 2020. Using Emerging Hot Spot Analysis (EHSA), a two-stage distributed lag nonlinear model (DLNM), and a hierarchical Bayesian spatiotemporal model, we assessed the integrated effects of meteorological and socioeconomic factors on TB dynamics. EHSA revealed persistent spatial clustering in western China, with Sichuan and Yunnan identified as Emerging Hot Spots and Xinjiang, Xizang (Tibet), and Qinghai as Sporadic Hot Spots. The increasing trend in Global Moran’s I from 0.231 in 2005 to 0.499 in 2020 indicates an intensification of spatial clustering and geographic disparities over the study period. A nonlinear temperature-incidence relationship was identified, with elevated risk below \\(\\varvec{7.5^{\\circ }\\textrm{C}}\\) and above \\(\\varvec{22^{\\circ }\\textrm{C}}\\) , reflecting seasonal behavioral patterns. DLNM analysis also indicated that the relative risk continuously decreased as the lag time increased, with effects distributed over a 3-month lag. Socioeconomic analysis indicated that public transport passenger volume was associated with higher TB risk, whereas per capita GDP, education level, and particulate emissions control appeared protective. The negative association between total particulate emissions and TB incidence likely reflects the strong correlation between emissions and economic development rather than a direct protective effect. No significant link was found with the number of health institutions, suggesting that equitable healthcare investment has mitigated regional disparities. These findings highlight the importance of integrated, region-tailored strategies that address environmental exposure, population mobility, and socioeconomic conditions to advance the WHO End TB goals by 2035.