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Background <p>Tuberculosis (TB) remains a major public health challenge in Thailand, a high-burden country undergoing both epidemiological transition and pandemic-related disruption. This study examined temporal and spatial patterns of age-standardized TB incidence from 2012 to 2023 across Thailand’s 13 health regions and 77 provinces.</p> Methods <p>This nationwide ecological study used annual TB case notifications (2012–2023) for all 77 Thai provinces from Thailand's National Disease Surveillance System (Report 506), Bureau of Epidemiology, with mid-year and age-stratified provincial populations. Age-standardized incidence rates (ASR) were calculated using the WHO World Standard Population (2000–2025). Temporal trends were assessed by Joinpoint regression with Bayesian-Information-Criterion model selection (maximum 2 joinpoints) and validated by generalized additive models. Spatial clustering was evaluated by Global Moran’s <i>I</i> and Local Indicators of Spatial Association (LISA) under queen contiguity, with sensitivity analyses across alternative weights and Benjamini–Hochberg false-discovery-rate correction. Provinces were classified into long-term trend categories combining effect size (AAPC) and significance, and COVID-19 impact was quantified by 2019–2023 ASR percent change.</p> Results <p>National TB incidence declined substantially from 2012 to 2023, although marked regional heterogeneity persisted. Five health regions showed the strongest long-term reductions: region 3 [AAPC: − 20.51, 95% confidence interval (<i>CI</i>)<i>:</i> − 33.00 to − 13.77], region 9 (− 19.42, 95% <i>CI:</i> − 28.98 to − 8.57), region 4 (− 17.53, 95% <i>CI:</i> − 23.64 to − 12.89), region 11 (− 11.79, 95% <i>CI:</i> − 22.16 to − 0.04), and region 13 (− 11.19, 95% <i>CI:</i> − 22.44 to − 3.74). Region 6 showed an early decline followed by stabilisation, and region 12 showed a mid-period increase before a post-2019 reduction.</p> Conclusions <p>Thailand has achieved substantial overall reductions in TB incidence over the past decade, but pronounced regional and provincial disparities persist. Localized hot-spots, biphasic regional trajectories that may reflect surveillance and programmatic transitions, and compound vulnerability during the COVID-19 period underscore the need for geographically targeted monitoring, equitable resource allocation, and pro-poor interventions to sustain progress toward TB elimination.</p>

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Spatiotemporal trends in tuberculosis incidence in Thailand, 2012–2023: a nationwide, province-level analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月1日

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  • Kittipong Sornlorm,
  • Roshan Kumar Mahato,
  • Sarayu Muntaphan,
  • Kanit Hnuploy,
  • Rajitra Nawawonganun

摘要

Background

Tuberculosis (TB) remains a major public health challenge in Thailand, a high-burden country undergoing both epidemiological transition and pandemic-related disruption. This study examined temporal and spatial patterns of age-standardized TB incidence from 2012 to 2023 across Thailand’s 13 health regions and 77 provinces.

Methods

This nationwide ecological study used annual TB case notifications (2012–2023) for all 77 Thai provinces from Thailand's National Disease Surveillance System (Report 506), Bureau of Epidemiology, with mid-year and age-stratified provincial populations. Age-standardized incidence rates (ASR) were calculated using the WHO World Standard Population (2000–2025). Temporal trends were assessed by Joinpoint regression with Bayesian-Information-Criterion model selection (maximum 2 joinpoints) and validated by generalized additive models. Spatial clustering was evaluated by Global Moran’s I and Local Indicators of Spatial Association (LISA) under queen contiguity, with sensitivity analyses across alternative weights and Benjamini–Hochberg false-discovery-rate correction. Provinces were classified into long-term trend categories combining effect size (AAPC) and significance, and COVID-19 impact was quantified by 2019–2023 ASR percent change.

Results

National TB incidence declined substantially from 2012 to 2023, although marked regional heterogeneity persisted. Five health regions showed the strongest long-term reductions: region 3 [AAPC: − 20.51, 95% confidence interval (CI): − 33.00 to − 13.77], region 9 (− 19.42, 95% CI: − 28.98 to − 8.57), region 4 (− 17.53, 95% CI: − 23.64 to − 12.89), region 11 (− 11.79, 95% CI: − 22.16 to − 0.04), and region 13 (− 11.19, 95% CI: − 22.44 to − 3.74). Region 6 showed an early decline followed by stabilisation, and region 12 showed a mid-period increase before a post-2019 reduction.

Conclusions

Thailand has achieved substantial overall reductions in TB incidence over the past decade, but pronounced regional and provincial disparities persist. Localized hot-spots, biphasic regional trajectories that may reflect surveillance and programmatic transitions, and compound vulnerability during the COVID-19 period underscore the need for geographically targeted monitoring, equitable resource allocation, and pro-poor interventions to sustain progress toward TB elimination.