Global Geographical Distribution of Mycobacterium Tuberculosis Complex and the Association Between GHSI and Drug-Resistance

Abstract Background Mycobacterium tuberculosis complex (MTBC) is the causative agent of tuberculosis (TB). This study aims to map the global distribution of MTBC lineage and to explore the correlation between Global Health Security Index (GHSI) and drug resistance. Methods We mapped the global geographic distribution of MTBC lineages using the whole-genome sequencing (WGS) and verified data from the TBProfiler. The hierarchical structure was visualized in different continents and sublineages. We also performed two-dimensional twisted surface and interaction plots to explore the interactions. Results Lineage 4 was widely distributed globally, while lineage 2 had the highest risk of developing DR-TB. We observed an interaction between GHSI and GDP on the prevalence of multidrug-resistant TB. In countries with ln(GDP per capita) ≥2.35, there was a negative association between GHSI and drug resistance. Conclusions There was a significantly different geographic distribution pattern of MTBC lineages in the world. The GHSI was related to the drug resistance of TB and was affected by the social-economic level.