Gonorrhea poses a major public health challenge. This study analyzed the independent effects of age, period, and birth cohort on gonorrhea incidence in Eastern China to inform targeted interventions. Case data from Zhejiang Province (2005–2024) were obtained from the China Information System for Disease Control and Prevention. Age-Period-Cohort and Joinpoint regression models were used to evaluate trends and effects. A total of 347,868 gonorrhea cases were reported, with an average annual incidence of 31.87 per 100,000 and a male-to-female ratio of 3.66. Joinpoint analysis identified three distinct trends: a significant decrease during 2005–2012 (Annual Percentage Change=-10.56

Environmental exposures, particularly air pollutants, are important determinants of pulmonary tuberculosis (PTB) incidence and mortality. However, limited evidence exists on whether greenspace exposure influences PTB treatment outcomes, and little is known about how such effects vary across spatial scales or interact with air pollutants during treatment. This study examined the scale-specific associations between greenspace exposure and PTB treatment success and assessed whether greenspace modified the associations between air pollutants and treatment outcomes within 250, 500, and 1250 m residential buffers. Using data from 82,784 PTB cases in Zhejiang Province, we applied multivariate Cox proportional hazards models to estimate associations between greenspace exposure and treatment success across multiple spatial scales. Interaction analyses were further conducted to evaluate the joint effects of greenspace and air pollutants on PTB treatment outcomes. Greenspace exposure within the 1250 m buffer showed the strongest positive association with PTB treatment success. Compared with patients in the lowest quintile of greenspace exposure, those in the fourth quintile within the 1250 m buffer were significantly more likely to achieve treatment success (HR = 1.0701, 95

Community-based chest X-ray (CXR) screening has been widely performed to improve tuberculosis identification in elderly populations, but comparative evidence against mode of symptom-driven case finding remains scarce. We conducted three annual rounds of mass CXR screening among individuals aged over 60 years in Lanxi City, China, from 2021 to 2023. Tuberculosis cases identified through CXR screening were compared with concurrent, symptom-driven case presentations via routine surveillance. Restricted cubic spline and multivariable logistic regression analyses were used to examine factors associated with distinct detection pathways. At the individual level, a total of 831 tuberculosis cases were identified through two modes. CXR mass screening detected more patients with less typical symptoms, while symptom-driven detection was more effective in females (aOR = 0.59, 95

BackgroundRecurrent pulmonary tuberculosis (PTB) after successful treatment is a significant challenge for current TB control efforts. This study investigated the epidemiological characteristics of recurrent PTB in western Zhejiang Province, aiming to identify risk factors for recurrence and predictors of retreatment outcomes, thereby providing a scientific basis for targeted prevention and management.MethodsThis retrospective cohort study utilized surveillance data from the Tuberculosis Information Management System in Quzhou, Zhejiang, from January 1, 2007, to December 31, 2024. Recurrence-free intervals were analyzed to identify temporal patterns, and multivariable Cox proportional hazards regression models were employed to determine independent risk factors for recurrence and adverse retreatment outcomes.ResultsAmong 28,458 patients, 897 (3.15%) experienced recurrence. These cases were predominantly male (79.2%), older (mean age, 61.6 years), and farmers (80.3%). Recurrence-free intervals significantly shortened with subsequent episodes, dropping from a median of 804 days (95% CI, 740–900) for the first recurrence to 495 days (95% CI, 394–737) for the second (p < 0.001). Nearly half (48.9%) of all recurrences occurred within the first 2 years after treatment. Independent predictors of recurrence included advanced age (Adjusted HR, 1.77 for ≥65 years [95% CI, 1.46–2.16]), male sex (AHR, 1.42 [95% CI, 1.21–1.67]), and farming occupation (AHR, 1.22 [95% CI, 1.02–1.46]). For retreatment outcomes, age ≥65 years was the independent risk factor for adverse events (AHR, 1.91 [95% CI, 1.07–3.40]).ConclusionNearly half of the recurrences occurred within 2 years after treatment completion, and recurrence-free intervals progressively shortened with repeated episodes. The older population (≥65 years) faced a dual burden, identified as the primary risk group for both recurrence and adverse retreatment outcomes. For the risk factors of recurrence and the success of treatment, it is necessary to further refine and explore the influencing factors.

ObjectiveTo identify the composition of comorbidities among patients with newly diagnosed pulmonary tuberculosis and assess the impact of comorbidities on the clinical characteristics of patients.MethodsThis study was conducted in 13 hospitals across 13 counties in Zhejiang province, China. Patient data collected in this study included demographic characteristics, chest radiography results, etiological results, and comorbidities. Descriptive statistics were conducted to describe the composition of comorbidities of all participants. Univariate and multivariate logistic regression analyzes were performed to identify the effects of comorbidities on the clinical features of the participants.ResultsOf the 8,421 total participants, 27.6% reported cavities in the chest radiography results, 41.9% were Mycobacterium tuberculosis-positive in the etiology test results, and 38.7% (3,258/8,421) had at least one type of comorbidity. The most predominant comorbidity was pleuritis (1,833, 21.8%), followed by diabetes mellitus (763, 9.1%), other extrapulmonary tuberculosis (421, 5%), tracheobronchial tuberculosis (275, 3.3%), and silicosis (160, 1.9%). Participants with diabetes mellitus had the highest rate of chest cavities on X-ray (54.8%), followed by those with silicosis (33.1%). In addition, a higher percentage of the M. tuberculosis-positive etiology (45%) was observed in participants without comorbidities than in participants with comorbidities (37.1%). Compared to patients without comorbidities, patients with diabetes mellitus (adjusted odds ratio [AOR]: 2.88, 95% confidence interval [CI]: 2.42–3.43) were more likely to show cavities in chest X-ray, while patients with pleuritis (AOR: 0.27, 95% CI: 0.23–0.32), other extrapulmonary tuberculosis (AOR: 0.48, 95% CI: 0.36–0.64), and tracheobronchial tuberculosis (AOR: 0.40–0.79) were less likely to show chest cavities in X-ray. In addition, patients with diabetes mellitus (AOR: 2.05, 95% CI: 1.72–2.45), tracheobronchial tuberculosis (AOR: 3.22, 95% CI: 2.4–4.32) were more likely to show Mycobacterium tuberculosis-positive in the etiology, and patients with pleuritis (AOR: 0.25, 95% CI: 0.22–0.29), other extrapulmonary tuberculosis (AOR: 0.61, 95% CI: 0.48–0.76) were less likely to show Mycobacterium tuberculosis-positive in the etiology.ConclusionThe prevalence of comorbidities was high in patients newly diagnosed with pulmonary tuberculosis. Thus, integration of screening and personalized management is needed for the control of tuberculosis and its comorbidities.

Individuals with asymptomatic tuberculosis (TB) are considered a significant risk to the disease burden and transmission. However, the progression and treatment for asymptomatic TB remain incompletely described. This prospective cohort study was embedded within a prevalence survey conducted in 2021 and 2022 in Lanxi County, China. All patients with pulmonary TB who consented to participate would be included in the study and were categorized as asymptomatic or symptomatic. For the primary analysis, asymptomatic TB was defined as the absence of current cough, fever, night sweats, weight loss, or hemoptysis. Patients were followed up until 10 November 2024. Among 109 345 individuals screened, 193 were included, of whom 101 (52.3%) were symptomatic and 92 (47.7%) were asymptomatic. The proportion of asymptomatic TB varied from 32.5% to 62.7% depending on varying symptom negative threshold. Fewer asymptomatic patients were bacteriologically confirmed compared to symptomatic patients (71.7% [66/92] vs 90.1% [91/101], P = .001). The median time for asymptomatic patients at screening to develop symptoms was 102 days. Most patients in both groups received treatment for active TB (97.8% vs 99.0%, P = .606). The treatment success rate among asymptomatic patients was comparable to that of symptomatic patients (93.3% vs 96.0%, P = .521), but their treatment duration was significantly shorter (196 vs 273 days, P < .001). In the community setting, a significant number of TB cases were asymptomatic and remained so for months. These cases demonstrated satisfactory treatment coverage and outcomes, with shorter durations compared to symptomatic TB, suggesting the potential for developing shorter regimens for asymptomatic TB.

Background:Hepatitis B virus (HBV) infection poses a significant public health challenge in China. The Prevention of mother-to-child Transmission (PMTCT) strategy of combining universal hepatitis B vaccination with hepatitis B immunoglobulin (HBIG) for newborns is crucial in preventing widespread infection. In this study, we conduct health economic evaluation of three strategies: PMTCT, universal vaccination, and non-vaccination for newborns in Ningbo, China. Methods:This study developed a decision-Markov model and simulated a cohort of 100,000 newborns to assess the cost-effectiveness and cost-benefit of three strategies from a healthcare system perspective. The primary outputs included total costs, life-years (LYs), quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), benefit-cost ratios (BCRs). One-way and probabilistic sensitivity analyses (PSA) were performed to verify the robustness of the model. Results:Among the three strategies, the PMTCT results in the least disease burden and mortality related to hepatitis B. In comparison to a cohort of 100,000 unvaccinated infants, the PMTCT is expected to prevent 6,029 cases of acute symptomatic infections, 27,348 HBV carriers, 4,170 chronic infections, 3,597 cases of cirrhosis, 2,911 cases of hepatocellular carcinoma (HCC), and 3,930 HBV-related deaths. The ICERs for PMTCT and universal vaccination were - 56,371.77 yuan/QALY and - 56,654.77 yuan/QALY, respectively. The BCRs for PMTCT and universal vaccination were 19.13 and 15.95, respectively, when compared to no vaccination. The PSA revealed that all ICER scatter points are situated within the fourth quadrant, and the probability of PMTCT being cost-effective exceeds 90%. Conclusion:Implementing universal hepatitis B vaccination with HBIG for newborns in Ningbo demonstrated high cost-effectiveness, making the continuation of the PMTCT strategy highly recommended.

Sarcopenia has become a critical health concern in the global older population. However, limited studies have investigated the epidemiological characteristics and potential risk factors of sarcopenia in older individuals residing in rural coastal areas of China. This cross-sectional study involving sarcopenia screening was conducted in Ningbo City, including body composition measurements, and questionnaire surveys. Sarcopenia was diagnosed using the criteria outlined in the Asian Working Group for Sarcopenia 2019 Consensus. A total of 902 older adults aged ≥ 60 years (average age: 69.76 years) were included using a two-stage random sampling method from three villages in Ningbo. The prevalence of sarcopenia was 11.53%, with men (16.36%) exhibiting higher rates than women (7.93%). Multivariate logistic regression analysis identified age (odds ratio [OR]: 6.708, 95% confidence interval [CI]: 2.520–17.855), stroke (OR: 9.232, 95% CI: 1.917–44.447), and waist circumference (OR: 1.095, 95% CI: 1.030–1.165) as factors positively correlated with the occurrence of sarcopenia. Conversely, body mass index (OR: 0.347, 95% CI: 0.270–0.445) was negatively correlated with sarcopenia development. These findings underscore the need for specific health education, the collaborative prevention of comorbidities, and active screening for sarcopenia in the older population to reduce its disease burden.

Tuberculosis remains a major public health challenge worldwide. This study aimed to determine the long-term trends in the notification rate of tuberculosis in Zhejiang Province, and to assess the potential independent risks associated with age, time period, and birth cohort. Data on all pulmonary tuberculosis (PTB) cases in Zhejiang Province from 2008 to 2022 were collected from the Tuberculosis Information Management System. Long-term trends in the notification rate and independent risks associated with quantitatively decomposed variables were determined using joinpoint regression model and age-period-cohort model. Between 2008 and 2022, a total of 323,745 PTB cases were notified in Zhejiang Province. Overall, the notification rate declined, with notable turning points in 2010 and 2019. Net drift analysis revealed an average annual decrease of 5.7

Tuberculosis (TB), particularly pulmonary tuberculosis (PTB), remains a major public health issue in China. It ranks as the second-leading cause of infectious disease mortality in China. Previous studies have documented the impacts of particulate matter with diameters <= 2.5 mu m (PM2.5) and greenspace on TB outcomes independently. However, the interaction effects between greenspace morphology and PM2.5 on TB risk, especially across urban and rural contexts, remain unclear. To address this knowledge gap, we conducted a Cox proportional hazards regression analysis using data from 42,331 PTB patients in Zhejiang Province between 2015 and 2019. Our objective was to explore the influence of greenspace morphology on PTB treatment success in relation to PM2.5, with a specific emphasis on elucidating urban-rural disparities. The results revealed a significant interaction between greenspace morphology and PM2.5. This interaction impacted PTB treatment success differently across urban and rural settings at varying spatial scales. Specifically, in urban areas, while greenspace morphologies did not exhibit significant effects at the community level, the percentage of greenspace and the mean area at the block level significantly influenced PTB treatment success. Conversely, in rural areas, all types of greenspace morphologies showed significant effects at the community level, except for the mean area, which was not significant at the block level. To enhance the treatment success of PTB patients, we recommended increasing the number of greenspaces at the community level while also improving their size at the block level in urban areas. In rural areas, efforts should focus on maintaining favorable greenspace morphologies (except for mean area) at the community level and enhancing them while simultaneously reducing PM2.5 levels at the block level. These findings not only highlight the importance of mitigating health inequities between urban and rural areas, but also provide insights for developing targeted greenspace strategies aimed at promoting successful PTB treatment.

Up to now, tuberculosis (TB) remains a global public health problem, posing a serious threat to human health. Traditional methods for analyzing time-varying trends, such as age and period, tend to ignore the poor impact of birth cohorts, which is an important factor in the development of TB. The age-period-cohort (APC) model, a statistical method widely used in recent decades in economics, sociology, and epidemiology, can quantitatively estimate the efficacy of different age, period, and birth cohort groups for TB by separating the effects of these three dimensions and controlling for confounding factors among the time variables. The purpose of this paper is to briefly review the model, focus on the application of the existing APC model in the field of TB, and explain its advantages and disadvantages. This study will help to provides a theoretical basis and reference for using the APC model in TB analysis and prediction.

Various ambient air pollutants within a mixture may interact with each other and amplify or reduce the cumulative effects of individual air pollutants on health outcomes. However, health-related studies on the interactive effects of air pollutant mixtures remain limited. Additionally, the influence of greenness on health outcomes in the context of air pollutant mixtures has seldom been explored. To develop a joint analysis framework that focuses on the interactive effects among pollutants to evaluate the combined effects of ambient air pollutant mixtures on pulmonary tuberculosis (PTB) risks, taking into account greenness as a moderating factor. In this case–control study conducted in Lanxi, China, 1128 newly diagnosed PTB cases from 2019 to 2021 were matched with 2256 controls by sex and age. To evaluate exposure, the 24-month average values of particulate matter with aerodynamic diameters of ≤ 2.5 µm (PM2.5), sulfur dioxide (SO2), ozone (O3), nitrogen dioxide (NO2), and the Normalized Difference Vegetation Index before diagnosis or study entry were assessed using a high-resolution dataset. A quantile-based g-computation model was then used to estimate the additive and interactive effects of air pollutants on PTB risks and identify the moderating influence of greenness on these relationships. Additive effect models showed that a one quartile increase in exposure to the air pollutant mixture was associated with elevated PTB risks (mixture odds ratio: 1.17, 95

BACKGROUND:Hepatitis significantly increases the global disease burden and has become a major public health issue worldwide. China is a high-risk area for viral hepatitis, which is also a serious public health problem. METHODS:The scaling relationship between various types of hepatitis and population size was explained by a scaling law. Fixed-effects and random-effects meta-analyses were used to calculate a combined index of β based on the single-scale index from 2004 to 2023. Furthermore, the X11 process was employed to identify the structural components of the time series of various types of hepatitis. RESULTS:In the past 20 years, the proportion of patients with viral hepatitis in Zhejiang Province has changed significantly, and hepatitis B remains the main type of hepatitis, accounting for approximately 70% of all hepatitis cases. The proportion of hepatitis C and E cases has been increasing, whereas the proportion of hepatitis A cases has been decreasing since 2004 and has remained at a low level (approximately 3%) since 2010. The combined scaling exponents of hepatitis A, hepatitis B, hepatitis C, hepatitis E and unclassified hepatitis based on the random effects model were 0.88 (95% confidence interval(CI): 0.78 to 0.98), 0.78 (95% CI: 0.70 to 0.86), 1.18 (95% CI: 1.11 to 1.26), 0.91 (95% CI: 0.86 to 0.97) and 0.89 (95% CI: 0.79 to 1.00), respectively. CONCLUSION:In the past 20 years, the epidemic situation of hepatitis A, hepatitis B and unclassified hepatitis has shown a significant downward trend, whereas the proportions of hepatitis C and hepatitis E among those with viral hepatitis have increased annually. The combined scaling exponent and development trends of the five types of hepatitis show significant heterogeneity. Overall, hepatitis C exhibits superlinear characteristics, whereas other types of hepatitis exhibit sublinear characteristics. Different types of hepatitis exhibit distinct epidemic characteristics and require targeted prevention and control measures.

Epidemiological studies have found inconsistent relationships between air pollutants and the risk of pulmonary tuberculosis (PTB), possibly due to variations in exposure windows and limited attention to environmental modifiers such as greenness. However, few studies has systematically examined how short- and long-term exposure to air pollution may differentially impact PTB risk, and how greenness may modify these associations. We utilized comprehensive data, including daily PTB incidence, air pollutants, meteorological data, and the normalized difference vegetation index (NDVI) from Zhejiang Province, China, spanning from 2013 to 2019. A distributed lag nonlinear model (DLNM) was employed to examine the relationships between air pollution and PTB incidence by county, and a meta-analysis was conducted to aggregate county-specific estimates. In the single-pollutant model, the lag-specific excess risk (ER) of PTB was 0.7% (95% CI 0.05%, 1.4%, 13-week lag) for each 0.1 mg/m 3 increase in carbon monoxide (CO). For each 10 µg/m 3 increase in the combined oxidant capacity (O X ), the lowest risk was a 0.9% decrease (95% CI −1.5%, −0.3%, 16-week lag). For each 10 µg/m 3 increase in particulate matter 2.5 (PM 2.5 ), the highest risk was a 1.7% increase (95% CI 0.8%, 2.6%, 19-week lag). Conversely, each 10 µg/m 3 increase in sulfur dioxide (SO 2 ) showed a dual association with PTB incidence, encompassing a short-term negative correlation and a long-term positive correlation. Furthermore, the associations between CO and PM 2.5 and PTB incidence were more pronounced in the male and working-age subgroups, whereas the associations with SO 2 were more significant in the female and elderly subgroups. Additionally, we observed that greenness negatively modified the relationship between short- and long-term exposure to O X and PTB incidence. Our findings revealed significant long-term lagged effects of CO, O X , and PM 2.5 on PTB incidence, as well as short- and long-term lagged effects of SO 2 . Furthermore, greenness was identified as a modifier of the association between O X and PTB incidence at various lag times.

BackgroundIn recent years, over-the-counter (OTC) drug sales have emerged as a novel indicator for symptom monitoring, attracting widespread attention in public health research globally. This study conducted weekly monitoring of five OTC drug categories related to fever respiratory system diagnostic cluster (FRSDC) — antitussive/expectorant drugs, cold medications, antibiotics, pungent and cool exterior-relieving agents, and influenza medicine — in Pinghu City, Zhejiang Province, from 2022 to 2024. Concurrently, weekly FRSDC cases from Pinghu First People’s Hospital were collected.MethodsSpearman correlation analysis was used to quantify associations between OTC sales and FRSDC cases, while decision tree models evaluated the reliability of OTC data for early prediction of FRSDC trends.ResultsResults showed significant positive correlations between all five OTC drugs and FRSDC cases, with synchronous seasonal peaks in winter and spring (Spearman’s correlation coefficients ranged from 0.36 to 0.80, all p value ≤ 0.0001). Even when OTC drug sales preceded FRSDC cases by one or two weeks, strong correlations persisted (Spearman’s correlation coefficients ranged from 0.28 to 0.79, p value ≤ 0.0001). Decision tree analysis revealed that combining antitussive/expectorant drugs and influenza medications effectively predicted FRSDC epidemics with 83.33% accuracy (adjusted p value < 0.05).ConclusionThese findings suggest that monitoring OTC drug sales may serve as a useful early warning indicator for FRSDC, potentially aiding public health response and resource planning.

Background In recent years, Shaoxing City, located in central Zhejiang Province, has experienced a slow decline in the incidence of pulmonary tuberculosis (PTB). Therefore, there is an urgent need to elucidate the potential causes for this decline through spatiotemporal analyses to provide a scientific basis for targeted prevention and control. We aimed to explore the spatiotemporal distribution of PTB notification rates in Shaoxing City from 2016 to 2024 and identify high-incidence clusters, thereby offering data-driven insights to optimize regional PTB control strategies.Methods Statistical analyses were conducted using R and Excel on all reported active PTB cases in Shaoxing City. Spatiotemporal analysis of case distribution and regional clustering was conducted using ArcGIS and SatScan.Results and discussion In total, 17,298 active PTB cases were registered between 2016 and 2024, including 9,749 laboratory-confirmed and 7,549 clinically diagnosed cases. The male-to-female ratio was 2.34:1. Farmers represented 68.2% of all cases. The PTB notification incidence showed a gradual decline. Spatial autocorrelation results revealed 52 sub-districts with high-high clusters over the nine-year period, primarily in Shengzhou and Xinchang counties. Spatiotemporal scan analysis identified one primary cluster area (RR = 1.62, LLR = 170.87, p < 0.001) and two secondary clusters between 2016 and 2024. The incidence of PTB in Shaoxing City showed a downward trend, though the decline was relatively slow. The southeastern region should be prioritized in efforts to accelerate the End TB Strategy. Overall, comprehensive and intensive interventions, such as large-scale chest X-ray screening and health education programs, should be enhanced to effectively curb PTB transmission, especially among males and farmers.

BACKGROUND:The burden of tuberculosis (TB) is increasingly borne by older adults. Several studies have investigated the prevalence of latent tuberculosis infection (LTBI) in special populations. However, the global estimates of the prevalence of LTBI in older adults are unclear. This study aimed to assess the prevalence of LTBI amongst older adults. METHODS:We conducted a systematic search of PubMed, Web of Science, Scopus and Embase databases. A systematic review and meta-analysis of relevant research articles published between 1 January 2000 and 28 February 2025 was performed. The I2 and Cochran's Q statistical tests were used to assess heterogeneity. Funnel plots and Egger's test were used to examine publication bias. Meta-regression and subgroup analyses were performed to assess the sources of heterogeneity. RESULTS:A total of 20 studies were finally included in this study after screening the articles. The overall pooled prevalence of LTBI in older adults was 31.1% [95% confidence intervals (CIs): 22.8%-39.3%]. Subgroup meta-analyses revealed significant differences in the prevalence of LTBI between countries when categorised by WHO regions and WHO TB incidence intervals. Besides, the prevalence of LTBI was 30.9% (95% CI: 23.9%-37.9%) and 33.4% (95% CI: 25.9%-40.8%) based on studies that utilized interferon-gamma release assay and tuberculin skin test, respectively. CONCLUSIONS:The prevalence of LTBI is relatively high amongst older adults, emphasising the high burden of undetected infection in this population. Future research integrating cost-effectiveness analyses and intervention studies is needed to further explore the feasibility of population-based screening and prevention strategies to promote TB prevention and control.

Background:China's aging population poses a growing challenge to disease burden. This study aims to evaluate the impact of population aging on the incidence of pulmonary tuberculosis (PTB) in Zhejiang Province, China. Methods:PTB notified incidence data reported to the National Notifiable Diseases Reporting System from 2005 to 2022 were analyzed. The notified incidence from 2023 to 2035 was estimated using exponential regression models. The decomposition algorithm was applied to decompose and quantify the effects of population aging, population growth, and age-specific incidence on the PTB incidence. Results:Between 2005 and 2022, the notified incidence of PTB in Zhejiang Province declined from 93.5 per 100,000 to 33.99 per 100,000. The highest notified incidence was observed in those aged 60 years and older, with the population attributable fraction increasing from 18.76 to 27.92%. During this period, PTB cases decreased by 51.22% compared to 2005, driven by a 23.83% increase due to population growth, a 10.26% increase due to age structure, and an 85.31% decrease due to age-specific incidence. The contribution of age structure to the increase in the number of cases was -1.92, -1.69%, 3.28, and 10.60% in the age groups 0-19, 20-39, 40-59, and ≥60 years, respectively. Conclusion:Notified incidence of PTB in Zhejiang Province is expected to decrease. However, this decrease may be affected by demographic changes, particularly in older adults. Thus, strengthening public health measures and policies is crucial to achieving the End TB Strategy goal by 2035, emphasizing the need to enhance PTB screening in older adults.

BackgroundUnderstanding health system delay (HSD) in pulmonary tuberculosis (PTB) diagnosis aids in tailoring interventions for case detection and curbing transmission. However, recent nationwide studies on HSD in PTB diagnosis have been scarce. This study assesses HSD and its risk factors in China, taking into account the impact of the COVID-19 epidemic.MethodsPatients diagnosed with PTB between 2019 and 2022 were selected using a multistage stratified clustering method. A semi-structured questionnaire was employed to assess HSD, which was defined as the interval between the patient’s initial visit to a health facility and the definitive PTB diagnosis. The HSD was then compared between 2019 (before the epidemic) and 2020–2022 (during the epidemic). Factors associated with long health system delay (LHSD, defined as HSD > 14 days) were examined using both univariate and multivariate analyses with chi-square tests and binary logistic regression, respectively.ResultsIn total, 958 patients with PTB were analyzed: 478 before and 480 during the epidemic. The HSD was 14 (interquartile range, 7–30) days for all patients, and the HSD before and during the epidemic also shared this value. A total of 199 patients (20.8%) had LHSD. LHSD was more prevalent in patients presenting solely with cough and expectoration (Odds ratio [OR]: 1.482, 95% confidence interval [CI]: 1.015–2.162) and those visiting ≥2 health facilities before definitive diagnosis (2 health facilities: OR = 2.469, 95%CI: 1.239–4.920; ≥3 health facilities: OR = 8.306, 95%CI: 4.032–17.111). Additionally, patients with negative bacteriological results were independently associated with higher LHSD risk (OR = 1.485, 95%CI: 1.060–2.080).ConclusionIn China, HSD in PTB diagnosis remains relatively low and is primarily mediated by factors associated with health providers. No significant impact on HSD from the COVID-19 epidemic has been found. Implementing targeted training programs to enhance health providers’ awareness of chronic respiratory symptoms and maintain vigilance for PTB; strengthening presumptive PTB identification capabilities at grassroots health facilities, and promoting the use of Mycobacterium tuberculosis (MTB) bacteriological technologies are recommended to shorten the HSD.

Background:The emergence of advanced diagnostic techniques and improved disease surveillance have led to increased recognition of psittacosis cases in recent years. This study aimed to characterize the epidemiological patterns and spatiotemporal distribution of psittacosis in Zhejiang Province, China, and to identify high-risk clusters through predictive modeling. Methods:We conducted a comprehensive analysis of reported psittacosis cases in Zhejiang Province from January 2019 to June 2024. Demographic characteristics and seasonal trends were systematically analyzed. Spatial epidemiological methods, including spatiotemporal distribution mapping, spatial autocorrelation analysis, and Kriging interpolation, were employed to identify disease hotspots and predict risk areas. Results:During the study period, 315 psittacosis cases were reported, with an annual average incidence rate of 0.0914 per 100,000 population, showing a significant increasing trend. The geographic distribution of cases expanded over time. More cases were reported in winter. Cases demonstrated a male predominance (sex ratio 1.1:1) with a median age of 64 years. Occupational analysis revealed farmers as the most affected group (52.4%). Spatial analysis identified significant clustering (Moran's I = 0.5428, P < 0.001), with high-incidence areas concentrated in western and central regions. Kriging interpolation predicted the highest disease risk in western Zhejiang, followed by central, southwestern and parts of northern regions. Western and southwestern regions had high risks of cluster. Conclusions:Our findings demonstrate a concerning upward trend in psittacosis incidence with expanding geographic distribution in Zhejiang Province. The identification of high-risk clusters in western, central, and northern regions provides critical evidence for targeted public health interventions, including enhanced surveillance in agricultural communities and seasonal prevention campaigns during winter months.