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Background <p>Tuberculosis (TB) is a global public health problem, particularly in China. Effective TB control is essential for achieving the World Health Organization’s End TB goal. This study aimed to analyze the age, period, and cohort effects on TB incidence trends from 2004 to 2023 and project the future TB burden until 2033 in Hubei, China.</p> Methods <p>Incidence data of pulmonary tuberculosis (PTB) from 2004 to 2023 were obtained from the National Notifiable Disease Reporting System. Age<b>‒</b>period<b>‒</b>cohort (APC) modeling was applied to analyze the effects of age, period, and cohort on PTB incidence. Bayesian age<b>‒</b>period<b>‒</b>cohort (BAPC) analysis with integrated nested Laplace approximations (INLA) was used to project PTB incidence from 2024 to 2033. We applied the decomposition algorithm to attribute incidence trends to population aging, population growth, and age-specific changes from 2004 to 2033.</p> Results <p>From 2004 to 2023, the incidence number of PTB decreased by 46.63% and the incidence rate decreased by 48.50%. APC analysis indicated that an overall annual percentage change (net drift) was − 5.45% (95% confidence interval (<i>CI)</i>: -5.93% to -4.97%) per year, with − 4.48% (95% <i>CI</i>: -4.97% to -3.99%) for females and − 5.86% (95% <i>CI</i>: -6.37% to -5.35%) for males. Period effects showed a decreasing trend, and the highest risk was observed from 2004 to 2008. Cohort effects showed that the later-born cohorts had lower risk, the cohort 1919–1923 had the highest risk (rate ratio [RR] = 18.97, 95% <i>CI</i>: 8.84–40.68), while the cohort 2019–2023 had the lowest risk (RR = 0.04, 95% <i>CI</i>: 0.004–0.33). The Bayesian APC model projected 23,284 PTB cases in Hubei Province in 2033, a decrease of 60.98% from 2004. Demographic decomposition analysis revealed that age-specific incidence was the primary driver of the increasing trend in PTB incidence from 2005 to 2033.</p> Conclusions <p>The overall incidence of tuberculosis in Hubei Province has decreased. However, demographic changes, particularly population aging, have partially offset the achievements in reducing PTB incidence. Our findings suggest the urgency of strengthening health systems to meet the health needs of the elderly and young adults, and the importance of large-scale screening and risk factor control for PTB control and prevention.</p>

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Trends and projection of pulmonary tuberculosis incidence in Hubei Province, china: an age‒period‒cohort modeling study

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  • 发表日期：

    2025年10月10日

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  • Yu Zhang,
  • Jianjun Ye,
  • Yeqing Tong,
  • Jun Yin,
  • Qin Da,
  • Xingxing Lu,
  • Qi Pi,
  • Zhixiong Shu,
  • Yuhe Xia,
  • Fan Wang,
  • Liping Zhou,
  • Liegang Liu

摘要

Background

Tuberculosis (TB) is a global public health problem, particularly in China. Effective TB control is essential for achieving the World Health Organization’s End TB goal. This study aimed to analyze the age, period, and cohort effects on TB incidence trends from 2004 to 2023 and project the future TB burden until 2033 in Hubei, China.

Methods

Incidence data of pulmonary tuberculosis (PTB) from 2004 to 2023 were obtained from the National Notifiable Disease Reporting System. Age‒period‒cohort (APC) modeling was applied to analyze the effects of age, period, and cohort on PTB incidence. Bayesian age‒period‒cohort (BAPC) analysis with integrated nested Laplace approximations (INLA) was used to project PTB incidence from 2024 to 2033. We applied the decomposition algorithm to attribute incidence trends to population aging, population growth, and age-specific changes from 2004 to 2033.

Results

From 2004 to 2023, the incidence number of PTB decreased by 46.63% and the incidence rate decreased by 48.50%. APC analysis indicated that an overall annual percentage change (net drift) was − 5.45% (95% confidence interval (CI): -5.93% to -4.97%) per year, with − 4.48% (95% CI: -4.97% to -3.99%) for females and − 5.86% (95% CI: -6.37% to -5.35%) for males. Period effects showed a decreasing trend, and the highest risk was observed from 2004 to 2008. Cohort effects showed that the later-born cohorts had lower risk, the cohort 1919–1923 had the highest risk (rate ratio [RR] = 18.97, 95% CI: 8.84–40.68), while the cohort 2019–2023 had the lowest risk (RR = 0.04, 95% CI: 0.004–0.33). The Bayesian APC model projected 23,284 PTB cases in Hubei Province in 2033, a decrease of 60.98% from 2004. Demographic decomposition analysis revealed that age-specific incidence was the primary driver of the increasing trend in PTB incidence from 2005 to 2033.

Conclusions

The overall incidence of tuberculosis in Hubei Province has decreased. However, demographic changes, particularly population aging, have partially offset the achievements in reducing PTB incidence. Our findings suggest the urgency of strengthening health systems to meet the health needs of the elderly and young adults, and the importance of large-scale screening and risk factor control for PTB control and prevention.