Age-period-cohort analysis shows declining bacteriologically confirmed pulmonary tuberculosis incidence in Hunan Province, China, 2009–2023.
Photo by National Institute of Allergy and Infectious Diseases / Unsplash
Key Takeaway
Consider prioritizing TB control for older adults and monitoring younger female cohorts for potential risk increases in Hunan Province.
This review utilized population-based surveillance data from Hunan Province, China, spanning 2009 to 2023, to evaluate trends in age-standardized reported incidence of bacteriologically confirmed pulmonary tuberculosis. The analysis employed age-period-cohort methods to examine temporal and demographic patterns within this specific geographic setting. No pharmacological interventions were evaluated, as the study focused on epidemiological trends rather than treatment efficacy or safety profiles.
The primary outcome indicated a general decline in incidence, quantified by an average annual percentage change (AAPC) of −2.20%. This decline was more pronounced among males, with an AAPC of −2.54%, whereas the decrease among females was not statistically significant. The age distribution revealed a bimodal pattern, with incidence peaks occurring in the 20–24-year and 80–84-year groups. Cohort effects demonstrated that risk peaked for those born between 1949 and 1953 before declining, while females born after 1994 showed early indications of possible increasing risk.
Safety and tolerability data were not reported, as the study design did not assess adverse events or drug discontinuations. Key limitations include the inability of conventional trend analyses to fully separate the independent effects of age, period, and birth cohort, a specific question not previously examined in Hunan Province. Consequently, causal inferences regarding specific risk factors are limited by the observational nature of the data.
The practice relevance of these findings suggests that tuberculosis control efforts should prioritize the increasing burden in older adults and closely monitor younger female cohorts for possible increases in risk. These results may help refine interventions for high-risk groups and optimize surveillance strategies in similar epidemiological contexts.
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View Original Abstract ↓
Trends in the incidence of bacteriologically confirmed pulmonary tuberculosis (PTB), a primary source of transmission, are important for targeted prevention and control. Hunan Province is a high-PTB-burden region in China. However, conventional trend analyses cannot separate the independent effects of age, period, and birth cohort, and this question has not been specifically examined in Hunan Province.
Using PTB surveillance data from Hunan Province (2009–2023), this study combined joinpoint regression and an age-period-cohort (APC) model to assess long-term trends in the reported incidence of bacteriologically confirmed PTB and quantify the independent effects of age, period, and birth cohort.
Over the study period, the age-standardized reported incidence of bacteriologically confirmed PTB declined (average annual percent change [AAPC], −2.20%). This decrease was more marked among males (AAPC, −2.54%), whereas the decline among females was not statistically significant. The decline plateaued after 2017, with an inflection point in 2020. APC analysis indicated a bimodal age pattern, with peaks in the 20–24 and 80–84-year age groups. The increase in incidence with age was greatest in the oldest age group. The period effects were statistically significant. The post-2017 plateau may be associated with changes in diagnostic practices and/or reporting, and the 2020 inflection point coincided with the COVID-19 pandemic. Cohort effects showed that risk peaked in the 1949–1953 birth cohort and then declined steadily; however, among females, cohorts born after 1994 showed early indications of a possible increasing risk.
APC analysis of bacteriologically confirmed PTB in Hunan Province showed a shifting epidemiology. These findings suggest that tuberculosis control efforts should prioritize the increasing burden in older adults and closely monitor younger female cohorts for possible increases in risk. These results may help refine interventions for high-risk groups and optimize surveillance strategies.
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