Trends and Projection of the Incidence of Active Pulmonary Tuberculosis in Southwestern China: Age-Period-Cohort Analysis (Preprint)

<sec> <title>BACKGROUND</title> The control of pulmonary tuberculosis (PTB) is critical for achieving the vision of World Health Organization’s End TB goal. </sec> <sec> <title>OBJECTIVE</title> This study analyzes the temporal trends in PTB incidence associated with age, period, and birth cohorts from 2006 to 2020 in Yunnan, China; projects the PTB burden till 2030; and explores the drivers of PTB incidence. </sec> <sec> <title>METHODS</title> The aggregated PTB incidence rates between 2005 and 2020 were obtained from the National Notifiable Disease Reporting System. We used the age-period-cohort model to evaluate the age, period, and cohort effects on PTB incidence. We applied the Bayesian age-period-cohort model to project future PTB incidence from 2021 to 2030. We applied the decomposition algorithm to attribute the incidence trends to population aging, population growth, and age-specific changes from 2006 to 2030. </sec> <sec> <title>RESULTS</title> From 2006 to 2020, the PTB incidence in Yunnan was relatively stable, although the absolute number showed an increase. The net drift was –1.56% (95% CI –2.41% to –0.70%). An M-shaped bimodal local drift and a longitudinal age curve were observed. The overall local drift was below zero for most age groups except for the age groups of 15-19 years (2.37%, 95% CI –0.28% to 5.09%) and 50-54 years (0.41%, 95% CI –1.78% to 2.64%). The highest risk of PTB incidence was observed in the age group of 65-69 years, and another peak was observed in the age group of 20-24 years. Downward trends were observed for both period and cohort effects, but the cohort effect trends were uneven. A higher risk was observed for the birth cohorts of 1961-1970 (rate ratio [RR]&lt;sub&gt;1961-1965&lt;/sub&gt;=1.10, 95% CI 0.88-1.38; RR&lt;sub&gt;1966-1970&lt;/sub&gt;=1.11, 95% CI 0.92-1.37) and 2001-2010 (RR&lt;sub&gt;2001-2005&lt;/sub&gt;=0.92, 95% CI 0.63-1.34; RR&lt;sub&gt;2006-2010&lt;/sub&gt;=0.84, 95% CI 0.45-1.58) than for the adjacent cohorts. The Bayesian age-period-cohort model projected that PTB incidence will continually increase from 2021 to 2030 and that PTB incidence in 2030 will be 2.28 times higher than that in 2006. The age-specific change was the leading cause for the growing PTB disease burden. </sec> <sec> <title>CONCLUSIONS</title> Although there are several levels and measures for PTB control, the disease burden is likely to increase in the future. To bridge the gap of TB-free vision, our study suggests that public health policies be put in place soon, including large-scale active case-finding, priority prevention policies for high-risk older adult and young adult populations, and reduction of possible grandparent-grandchildren transmission patterns. </sec>