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Background <p>Non-tuberculous mycobacteria (NTM) cause pulmonary diseases that resemble tuberculosis and are frequently misdiagnosed in TB-endemic settings, leading to inappropriate treatment. This study aimed to determine the prevalence of NTM pulmonary disease (NTMPD) among patients presumed to have pulmonary TB in China, and to evaluate the impact of ecological, climatic, and socioeconomic factors on NTMPD identification.</p> Methods <p>Data on notification cases between January 1, 2011 and December 31, 2020 were from the National TB Information Management System (TBIMS). Joinpoint regression models were used to analyze temporal trends in NTMPD prevalence and its spatial variability. A random forest model was employed to assess the effects of ecological, climatic, and socioeconomic factors on NTMPD identification.</p> Results <p>NTMPD cases are concentrated primarily in the eastern and southeastern coastal regions of China. NTMPD prevalence shows an annual decline (AAPC = −1.64%, 95% CI: −2.76% to −0.51%). Random forest analysis identifies annual average temperature (mean importance = 5.51%, 95% CI: 3.50% to 7.53%), GDP (mean importance = 3.60%, 95% CI: 2.19% to 5.01%), and water coverage area (mean importance = 3.45%, 95% CI: 1.73% to 5.16%) as key predictors of NTMPD identification. In 2020, 573 counties remain classified as neglected high-risk areas.</p> Conclusions <p>NTMPD in China exhibits spatial heterogeneity and a declining temporal trend, with identification influenced by ecological, climatic, and socioeconomic factors. These findings highlight the need for targeted surveillance and diagnostic capacity strengthening, particularly in neglected high-risk areas.</p>

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Prevalence of non-tuberculous mycobacterial pulmonary diseases among TB cases in China using random forest socioeconomic factors

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月27日

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  • Tao Li,
  • Haoliang Cui,
  • Jia Wang,
  • Jianyi Zhang,
  • Xin Du,
  • Yanlin Zhao,
  • Zhongwei Jia

摘要

Background

Non-tuberculous mycobacteria (NTM) cause pulmonary diseases that resemble tuberculosis and are frequently misdiagnosed in TB-endemic settings, leading to inappropriate treatment. This study aimed to determine the prevalence of NTM pulmonary disease (NTMPD) among patients presumed to have pulmonary TB in China, and to evaluate the impact of ecological, climatic, and socioeconomic factors on NTMPD identification.

Methods

Data on notification cases between January 1, 2011 and December 31, 2020 were from the National TB Information Management System (TBIMS). Joinpoint regression models were used to analyze temporal trends in NTMPD prevalence and its spatial variability. A random forest model was employed to assess the effects of ecological, climatic, and socioeconomic factors on NTMPD identification.

Results

NTMPD cases are concentrated primarily in the eastern and southeastern coastal regions of China. NTMPD prevalence shows an annual decline (AAPC = −1.64%, 95% CI: −2.76% to −0.51%). Random forest analysis identifies annual average temperature (mean importance = 5.51%, 95% CI: 3.50% to 7.53%), GDP (mean importance = 3.60%, 95% CI: 2.19% to 5.01%), and water coverage area (mean importance = 3.45%, 95% CI: 1.73% to 5.16%) as key predictors of NTMPD identification. In 2020, 573 counties remain classified as neglected high-risk areas.

Conclusions

NTMPD in China exhibits spatial heterogeneity and a declining temporal trend, with identification influenced by ecological, climatic, and socioeconomic factors. These findings highlight the need for targeted surveillance and diagnostic capacity strengthening, particularly in neglected high-risk areas.