Abstract:

Objective: To analyze the epidemiological characteristics and reported incidence trends of pulmonary tuberculosis (PTB) in Shanghai from 2009 to 2023 using a Joinpoint regression model, and to provide a scientific basis for evaluating the effectiveness of TB control measures and optimizing strategies. Methods: Data on PTB cases in Shanghai from 2009 to 2023—including reported incidence counts, population classification, household registration status, etiological classification, and occupational classification—were obtained from the “Communicable Disease Reporting Information Management System”, a subsystem of the “China Information System for Disease Control and Prevention”. Descriptive epidemiological methods were used to analyze characteristics of reported PTB incidence, and the Joinpoint regression model, annual percent change (APC), and average annual percent change (AAPC) were applied to evaluate temporal changes in PTB incidence. Results: From 2009 to 2023, the average annual reported PTB incidence rate in Shanghai was 26.49 per 100000 (93342/352.363 million), decreasing from 35.72 per 100000 (6745/18.885 million) in 2009 to 18.35 per 100000 (4541/24.746 million) in 2023, with an average annual percentage decline of 4.65% and an overall downward trend (AAPC=-5.429%, t=-2.790, P=0.005). The average annual etiological positivity rate was 48.56% (43242/89050), declining from 45.30% (3007/6638) in 2009 to 37.07% (2360/6367) in 2016, then increasing to 71.46% (3024/6232) in 2023, showing an overall upward trend (AAPC=3.033%, t=2.941, P=0.003). The decline in incidence among the non-registered resident population (AAPC=-10.503%) was faster than that among registered residents (AAPC=-3.350%), and since 2022, the incidence rate among non-registered residents had been lower than that of registered residents. The incidence rate in males (34.91 per 100000 (63283/181288000)) was significantly higher than in females (17.57 per 100000 (30059/171075000)), but the rate of decline (AAPC=-6.041%) was faster than that in females (AAPC=-4.312%). Among the elderly population (≥60 years), the incidence rate showed an overall declining trend, with AAPCs of -3.198% in the 60-74 year group and -7.996% in the ≥75-year group, but remained higher than that of other age groups. The proportions of retirees and unemployed individuals increased from 14.89% (1004/6745) and 13.49% (910/6745) in 2009 to 39.40% (1789/4541) and 29.29% (1330/4541) in 2023, respectively, both showing significant upward trends ( {\chi }_{trend}^2=3064.851 and 4504.868, both P<0.001). Conclusion: Significant progress has been achieved in TB prevention and control in Shanghai, as evidenced by a sustained decline in the reported incidence rate and a gradual improvement in the bacteriological positivity rate. Although the overall incidence among non-registered residents, males, the elderly, and individuals without employment has shown a downward trend, the incidence in these groups remains relatively high. It is recommended to continue strengthening the management of infectious sources and proactive screening of high-risk populations, and to integrate information technologies with precise intervention strategies to advance progress toward the goal of “End-TB”.

Key words: Tuberculosis, pulmonary, Incidence, Models, statistical, Regression analysis, Epidemiologic studies