Spatio-temporal distribution and clustering characteristics of comorbidities among tuberculosis inpatients in Guangdong Province from 2016 to 2024

doi:10.19982/j.issn.1000-6621.20250453

Chinese Journal of Antituberculosis ›› 2026, Vol. 48 ›› Issue (4): 448-458.doi: 10.19982/j.issn.1000-6621.20250453

• Original Articles • Previous Articles Next Articles

Spatio-temporal distribution and clustering characteristics of comorbidities among tuberculosis inpatients in Guangdong Province from 2016 to 2024

Ji Lianrong¹^,², Xue Yunlian²^,¹(), Jiang Xue³, Yuan Shasha⁴, Liu Guihao⁵, Wang Xiaowan⁶, Zou Xia⁷, Wang Tingting³, Zhou Zhanqi³, Zhou Lin⁸()

¹ School of Health Service Management，Southern Medical University，Guangzhou 510515，China
² Department of Statistics，Guangdong Provincial People’s Hospital，Guangdong Academy of Medical Sciences，Southern Medical University，Guangzhou 510080，China
³ Party Committee Office，Guangdong Provincial People’s Hospital，Guangdong Academy of Medical Sciences，Southern Medical University，Guangzhou 510080，China
⁴ Institute of Medical Information and Library，Chinese Academy of Medical Sciences and Peking Union Medical College，Beijing 100021，China
⁵ Department of Scientific Research，Guangdong Provincial People’s Hospital，Guangdong Academy of Medical Sciences，Southern Medical University，Guangzhou 510080，China
⁶ Division of Health Policy Research，Chinese Academy of Medical Sciences and Peking Union Medical College，Beijing 100021，China
⁷ Center of Global Health Research，Guangdong Provincial People’s Hospital，Guangdong Academy of Medical Sciences，Southern Medical University，Guangzhou 510080，China
⁸ Dean’s Office，Guangdong Provincial People’s Hospital，Guangdong Academy of Medical Sciences，Southern Medical University，Guangzhou 510080，China

Received:2025-11-16 Online:2026-04-10 Published:2026-04-02
Contact: Xue Yunlian，Email：xueyunlian@163.com；Zhou Lin，Email：zhoulin_z@foxmail.com
Supported by:
Guangdong Basic and Applied Basic Research Foundation(2024A1515011745);Guangdong Basic and Applied Basic Research Foundation(2025A1515012867);Science and Technology Program of Guangdong Province(2020B1111170014);Guangdong Philosophy and Social Science Foundation(GD24CGL39);Medical Science and Technology Research Foundation of Guangdong Province(C2020045)

Abstract

Abstract:

Objective：To analyze the characteristics of the comorbidity spectrum，spatio-temporal distribution pattern and spatial clustering mode of hospitalized tuberculosis patients in Guangdong Province from 2016 to 2024，so as to provide scientific evidence for regionalized and precise prevention and control. Methods：Based on the Guangdong Provincial Health Statistical Information Network Reporting System，the front page information of medical records of hospitalized tuberculosis patients （ICD-10：A15-A19） was extracted，and 20 common types of comorbidities were identified. Descriptive statistical analysis was adopted to analyze the epidemiological characteristics of comorbidities. Global and local Moran’s I were applied to examine the spatial autocorrelation and clustering characteristics of the major comorbidity combinations，namely tuberculosis-hypertension，tuberculosis-diabetes mellitus，and tuberculosis-chronic obstructive pulmonary disease. Results：A total of 729937 tuberculosis patients were enrolled，among whom 64.07% （467645/729937） had at least one comorbidity. The comorbidity rate of tuberculosis-hypertension increased from 13.71% （11285/82329） in 2016 to 21.00% （16697/79495） in 2024；that of tuberculosis-diabetes mellitus increased from 12.17% （10020/82329） to 19.53% （15524/79495）；and the comorbidity rate of tuberculosis-chronic obstructive pulmonary disease fluctuated from 9.28% （7229/77870） to 11.22% （9238/82329），remaining at approximately 10.00% overall. Spatial analysis revealed that the tuberculosis-hypertension exhibited a distribution pattern of “high in peripheral areas and low in core areas”，and the high-high clustering areas gradually shifted from multiple cities in the Pearl River Delta region （2016—2021，2023） to Jieyang City （2023—2024）. Tuberculosis-diabetes mellitus remained highly prevalent in eastern Guangdong，with the strongest spatial autocorrelation （Moran’s I>0.34）. Tuberculosis-chronic obstructive pulmonary disease showed a distribution pattern of “high in the north and low in the south”，and the high-high clustering areas were stably concentrated in northern Guangdong （2016—2024） and parts of eastern Guangdong （2016—2024）. Conclusion：The burden of tuberculosis comorbidities in Guangdong Province has continued to escalate with significant spatio-temporal heterogeneity and clustering characteristics. A regionalized and categorized precision prevention and control system should be established，and differentiated interventions should be implemented for the dominant comorbidity types in different regions，so as to enhance the overall prevention and control efficacy of tuberculosis comorbidities.

Key words: Tuberculosis, Comorbidity, Inpatients, Space-time clustering, Epidemiologic study characteristics as topic

CLC Number:

Ji Lianrong, Xue Yunlian, Jiang Xue, Yuan Shasha, Liu Guihao, Wang Xiaowan, Zou Xia, Wang Tingting, Zhou Zhanqi, Zhou Lin. Spatio-temporal distribution and clustering characteristics of comorbidities among tuberculosis inpatients in Guangdong Province from 2016 to 2024[J]. Chinese Journal of Antituberculosis, 2026, 48(4): 448-458. doi: 10.19982/j.issn.1000-6621.20250453

Figures/Tables 11

References 21

[1]	Motta I, Boeree M, Chesov D, et al. Recent advances in the treatment of tuberculosis. Clin Microbiol Infect, 2024, 30(9): 1107-1114. doi:10.1016/j.cmi.2023.07.013.
[2]	Xin H, Du J, Cao X, et al. Association of tuberculosis infection with the development of active tuberculosis and comorbidities in rural China: a 10-year follow-up results of a population-based, multicentre, prospective study. Lancet Reg Health West Pac, 2025, 61: 101659. doi:10.1016/j.lanwpc.2025.101659.
[3]	World Health Organization. WHO consolidated guidelines on tuberculosis: Module 6: Tuberculosis and comorbidities. Geneva: World Health Organization, 2024.
[4]	刘桂珍, 邓国防. 《结核病政策指南制订过程中发现的证据和研究缺口(第2版)》解读——结核病相关共病. 中国防痨杂志, 2024, 46(6): 618-624. doi:10.19982/j.issn.1000-6621.20240076.
[5]	胡轶君, 徐怡婷, 蹇荣华, 等. 2014—2019年广东省耐多药结核病时空分布特征与风险评估. 中国防痨杂志, 2025, 47(5): 639-646. doi:10.19982/j.issn.1000-6621.20240560.
[6]	Adegbite BR, Edoa JR, Agbo Achimi Abdul J, et al. Non-communicable disease co-morbidity and associated factors in tuberculosis patients: A cross-sectional study in Gabon. EClinicalMedicine, 2022, 45: 101316. doi:10.1016/j.eclinm.2022.101316.
[7]	Franco JV, Bongaerts B, Metzendorf MI, et al. Diabetes as a risk factor for tuberculosis disease. Cochrane Database Syst Rev, 2024, 8(8): CD016013. doi:10.1002/14651858.CD016013.pub2.
[8]	王宁, 冯曦兮, 龚胜, 等. 2020—2024年WHO报告解读:全球结核病报告与中国关键数据分析. 中国胸心血管外科临床杂志, 2025, 32(9): 1209-1215. doi:10.7507/1007-4848.202506002.
[9]	Cabral BVB, Monte GLA, Vasconcelos MN, et al. Spatial patterns and factors associated with the incidence of tuberculosis-diabetes in Brazil. Public Health, 2024, 233: 149-156. doi:10.1016/j.puhe.2024.05.023. pmid: 38897067
[10]	张梦迪, 王鑫, 郑文静, 等. 老年结核病危险因素研究进展. 中国防痨杂志, 2024, 46(10): 1266-1272. doi:10.19982/j.issn.1000-6621.20240255.
[11]	Kibirige D, Andia-Biraro I, Olum R, et al. Tuberculosis and diabetes mellitus comorbidity in an adult Ugandan population. BMC Infect Dis, 2024, 24(1): 242. doi:10.1186/s12879-024-09111-8. pmid: 38389045
[12]	Joo DH, Kim MC, Sin S, et al. Incidence and Risk Factors of Tuberculosis-Associated Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis, 2025, 20: 2091-2102. doi:10.2147/COPD.S523732.
[13]	Yin X, Wang Z, Li J, et al. Unveiling pathways to enhance hypertension and diabetes care in rural China: a mixed methods study using the care cascade model. Lancet Reg Health West Pac, 2025, 58: 101574. doi:10.1016/j.lanwpc.2025.101574.
[14]	Wang R, Zhong A, Ye J, et al. Life and health status of older migrants with hypertension in China: results from the 2018 China health and retirement longitudinal study. BMC Public Health, 2025, 25(1): 849. doi:10.1186/s12889-025-21550-9. pmid: 40033240
[15]	Peng P, Li J, Wang L, et al. An analysis of socioeconomic factors on multiple chronic conditions and its economic burden: evidence from the National Health Service Survey in Yunnan Province, China. Front Public Health, 2023, 11: 1114969. doi:10.3389/fpubh.2023.1114969.
[16]	吴惠忠, 周芳静, 邹霞, 等. 2013—2017年广东省涂阳肺结核时空分布特征. 中国防痨杂志, 2019, 41(12): 1283-1288. doi:10.3969/j.issn.1000-6621.2019.12.009.
[17]	Zhou F, Sun Q, Huang S, et al. Trends and delays in pulmonary tuberculosis diagnosis among elderly patients (≥60 Years) in Southern China: a 13-year surveillance data analysis (2010—2022). BMC Public Health, 2025, 25(1): 1854. doi:10.1186/s12889-025-23031-5.
[18]	屈燕, 李涛, 马文斌, 等. 世界卫生组织《2025年全球结核病报告》解读. 结核与肺部疾病杂志, 2025, 6 (6): 613-623. doi:10.19983/j.issn.2096-8493.20250178.
[19]	张颖, 叶云, 左秀英, 等. 肺结核合并糖尿病患者营养管理的最佳证据总结. 结核与肺部疾病杂志, 2025, 6(5): 538-543. doi:10.19983/j.issn.2096-8493.20250098.
[20]	Huang K, Zheng Z, Li W, et al. Sociodemographic correlates with prevalence of comorbidities in patients with chronic obstructive pulmonary disease: a study from a Chinese National Survey. Lancet Reg Health West Pac, 2023, 42: 100937. doi:10.1016/j.lanwpc.2023.100937.
[21]	Wu HZ, Li X, Wang JW, et al. Spatio-Temporal Pattern and Socio-economic Influencing Factors of Tuberculosis Incidence in Guangdong Province: A Bayesian Spatiotemporal Analysis. Biomed Environ Sci, 2025, 38(7): 819-828. doi:10.3967/bes2025.071. pmid: 40820248

城市	结核病	肺结核	肺外结核
广州市	140596（19.26）	122756（18.23）	21589（33.94）
韶关市	25606（3.51）	23818（3.54）	1835（2.88）
深圳市	65651（8.99）	58813（8.74）	8651（13.60）
珠海市	14922（2.04）	13683（2.03）	1554（2.44）
汕头市	45999（6.30）	43791（6.50）	2845（4.47）
佛山市	42849（5.87）	39404（5.85）	3436（5.40）
江门市	35366（4.85）	32837（4.88）	1960（3.08）
湛江市	47613（6.52）	44930（6.67）	2425（3.81）
茂名市	39534（5.42）	37178（5.52）	2409（3.79）
肇庆市	16729（2.29）	15404（2.29）	941（1.48）
惠州市	28370（3.89）	26382（3.92）	2193（3.45）
梅州市	24312（3.33）	22478（3.34）	1780（2.80）
汕尾市	11295（1.55）	10744（1.60）	515（0.81）
河源市	17231（2.36）	16403（2.44）	868（1.36）
阳江市	15078（2.07）	14178（2.11）	811（1.27）
清远市	33388（4.57）	32040（4.76）	1378（2.17）
东莞市	59357（8.13）	55927（8.31）	4280（6.73）
中山市	26639（3.65）	25217（3.75）	2091（3.29）
潮州市	7932（1.09）	7561（1.12）	378（0.59）
揭阳市	19565（2.68）	18369（2.73）	1098（1.73）
云浮市	11905（1.63）	11281（1.68）	574（0.90）
合计	729937（100.00）	673194（100.00）	63611（100.00）

共病疾病	合计		<45岁		45~59岁	≥60岁
高血压	125620（17.21）		4506（2.07）		26918（13.99）	94196（29.44）
糖尿病	115654（15.84）		11708（5.38）		42209（21.94）	61737（19.29）
慢性阻塞性肺疾病	75809（10.39）		788（0.36）		9997（5.20）	65024（20.32）
低蛋白血症	72841（9.98）		13126（6.03）		17098（8.89）	42617（13.32）
支气管扩张症	70233（9.62）		11757（5.40）		17537（9.12）	40939（12.79）
脑血管病	65002（8.91）		1637（0.75）		10545（5.48）	52820（16.51）
肺气肿	62058（8.50）		5895（2.71）		16053（8.34）	40110（12.54）
高尿酸血症	58490（8.01）		21919（10.07）		15530（8.07）	21041（6.58）
冠状动脉粥样硬化性心脏病	42393（5.81）		630（0.29）		6422（3.34）	35341（11.04）
恶性肿瘤	38579（5.29）		2937（1.35）		10328（5.37）	25314（7.91）
脂蛋白代谢紊乱和其他脂血症	36548（5.01）		6170（2.84）		13221（6.87）	17157（5.36）
动脉粥样硬化	36173（4.96）		598（0.27）		7502（3.90）	28073（8.77）
病毒性肝炎	29935（4.10）		10389（4.77）		11867（6.17）	7679（2.40）
慢性肾病	19707（2.70）		1947（0.89）		4973（2.59）	12787（4.00）
精神和行为障碍	13332（1.83）		3992（1.83）		3870（2.01）	5470（1.71）
肝硬化	12315（1.69）		1484（0.68）		5275（2.74）	5556（1.74）
营养不良	12137（1.66）		2889（1.33）		2490（1.29）	6758（2.11）
HIV感染	7035（0.96）	3238（1.49）		2378（1.24）		1419（0.44）
类风湿性关节炎	5610（0.77）		451（0.21）		1849（0.96）	3310（1.03）
哮喘	4442（0.61）		720（0.33）	1467（0.76）		2255（0.70）
合计	729937（100.00）		217579（100.00）		192374（100.00）	319984（100.00）

特征组别	例数	结核病-高血压			结核病-糖尿病			结核病-慢性阻塞性肺疾病
特征组别	例数	共病例数（共病率，%）	χ²值	P值	共病例数（共病率，%）	χ²值	P值	共病例数（共病率，%）	χ²值	P值
性别			792.85	<0.001		2924.31	<0.001		9588.64	<0.001
男性	525991	94596（17.98）			90910（17.28）			66080（12.56）
女性	203946	31024（15.21）			24744（12.13）			9729（4.77）
年龄组（岁）			69670.28	<0.001		26082.88	<0.001		59001.11	<0.001
<45	217579	4506（2.07）			11708（5.38）			788（0.36）
45~59	192374	26918（13.99）			42209（21.94）			9997（5.20）
≥60	319984	94196（29.44）			61737（19.29）			65024（20.32）

年份	结核病-高血压			结核病-糖尿病			结核病-慢阻肺病
年份	Moran’s I值	Z值	P值	Moran’s I值	Z值	P值	Moran’s I值	Z值	P值
2016	0.266	2.238	0.017	0.571	4.001	0.001	0.381	2.651	0.006
2017	0.250	2.103	0.021	0.404	2.971	0.004	0.378	2.643	0.005
2018	0.255	2.124	0.025	0.342	2.726	0.006	0.460	3.129	0.002
2019	0.263	2.188	0.020	0.580	4.039	0.001	0.406	2.879	0.005
2020	0.218	1.882	0.035	0.497	3.598	0.001	0.366	2.644	0.006
2021	0.227	1.848	0.049	0.420	2.933	0.004	0.320	2.396	0.010
2022	0.301	2.287	0.015	0.480	3.426	0.001	0.329	2.440	0.010
2023	0.211	1.763	0.053	0.478	3.522	0.001	0.364	2.641	0.008
2024	0.384	2.860	0.004	0.497	3.465	0.002	0.283	2.062	0.029

Spatio-temporal distribution and clustering characteristics of comorbidities among tuberculosis inpatients in Guangdong Province from 2016 to 2024

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 11

References 21

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	. Guidelines for the diagnosis and treatment of superficial lymph node tuberculosis with integrated traditional Chinese and Western medicine [J]. Chinese Journal of Antituberculosis, 2026, 48(4): 429-447.
[2]	Liu Xi, Liu Yuze, Hua Weiyu, Li Jie, Zhang Ying, Dong Bin. Epidemiological characteristics of pulmonary tuberculosis among residents in Haidian District，Beijing from 2012 to 2022 and its correlation with population density [J]. Chinese Journal of Antituberculosis, 2026, 48(4): 459-467.
[3]	Wang Yongbing, Zhong Yuexiang, Fu Xiuying, Zhang Ying, Weng Wenpei, Zhou Fangjing, Yang Yingzhou, Luo Jilun. Survey of Mycobacterium tuberculosis infection rate and analysis of associated factors among three priority populations in Yingde’s zero-TB community pilot areas，Guangdong Province [J]. Chinese Journal of Antituberculosis, 2026, 48(4): 468-476.
[4]	Miao Honghao, Zhang Jie, Pang Mengdi, Ren Yixuan, Deng Yang, Yi Junli, Fan Ruifang, Chen Shuangshuang, Chen Hao, Yu Lan, Li Jie, Li Chuanyou, Yang Xinyu. Genotypic and drug resistance of Mycobacterium tuberculosis in Beijing，2024 [J]. Chinese Journal of Antituberculosis, 2026, 48(4): 477-484.
[5]	Li Jing, Zhang Yangyi, Yang Jinghui, Wu Zheyuan, Li Ningdi, Yu Chenlei, Wang Lili, Shen Xuhui, Jiang Yuan, Shen Xin. Study on the characteristics of rpoB gene mutations in Mycobacterium tuberculosis and its correlation with rifampicin resistance level in Shanghai [J]. Chinese Journal of Antituberculosis, 2026, 48(4): 485-494.
[6]	Zhong Guowei, Zhang Shaoyi, Fan Huiling. Expression and clinical value of serum LncRNA LINC00707 and miR-382-5p in patients with pulmonary tuberculosis [J]. Chinese Journal of Antituberculosis, 2026, 48(4): 495-503.
[7]	Jiang Lina, Dai Wenxi, Ju Hanfang, Meng Sukai, Wang Chunhua. Clinical value of auramine O fluorescence staining automatic microscopic scanning and recognition system for detecting tuberculosis [J]. Chinese Journal of Antituberculosis, 2026, 48(4): 504-509.
[8]	Han Yanzhuo, Lu Zhenhui, Su Ben, Zhou Rui, Chen Jiajun, Wu Xianwei, Wu Dingzhong, Zhang Shaoyan, Qiu Lei. Analysis of the clinical characteristics of post-tuberculosis bronchiectasis [J]. Chinese Journal of Antituberculosis, 2026, 48(4): 510-517.
[9]	Gao Xianru, Cui Wenjuan, Zhang Mengran, Yang Kefan, Hao Huiyuan, Yang Lu, Sun Wenwen. Study on the health management journey map of 15 initially treated pulmonary tuberculosis patients [J]. Chinese Journal of Antituberculosis, 2026, 48(4): 518-524.
[10]	Yang Jie, Dong Ning, Wei Xiaowen, Wu Yan, Dong Wenfang, Wu Yuanhao, Zhang Lin. Effects of family participatory intervention on medication adherence and lung function based on health action process approach in elderly patients with pulmonary tuberculosis [J]. Chinese Journal of Antituberculosis, 2026, 48(4): 525-533.
[11]	Du Fangfang, Cao Xuefang, Wang Jin, Jin Qi, Liu Jianjun, Gao Lei, Cheng Shiming. Analysis of current developing situation of group standards of Chinese Antituberculosis Association [J]. Chinese Journal of Antituberculosis, 2026, 48(4): 534-540.
[12]	Zhou Wensi, Guo Meng, Chen Qingbo, Wang Quan, Li Wei. Comparative analysis of published literature in Chinese and English on multidrug-resistant tuberculosis from 2004 to 2025 [J]. Chinese Journal of Antituberculosis, 2026, 48(4): 541-549.
[13]	Qiu Yuxian, Huang Fang, Yang Xiaoyi, Yang Feng, Lu Hua, Zhang Tianyi, Zhang Yang, Yao Rong, Li Yuanyuan. Research progress in digital twin technology for tuberculosis patient management [J]. Chinese Journal of Antituberculosis, 2026, 48(4): 550-555.
[14]	Shu Wei, Liu Yuhong. Interpretation of research and innovation part of the WHO Global Tuberculosis Report 2025 [J]. Chinese Journal of Antituberculosis, 2026, 48(3): 307-312.
[15]	Wang Jing, Jing Wei, Li Weiwen, Zhu Qingdong, Pang Yu, Chu Naihui, Nie Wenjuan. Clinical cohort analysis of the efficacy and safety of extended-course bedaquiline in patients with multidrug-resistant/rifampicin-resistant pulmonary tuberculosis [J]. Chinese Journal of Antituberculosis, 2026, 48(3): 313-319.