title: Association between Multidrug-Resistant Tuberculosis and Risk Factors in China: Applying Partial Least Squares Path Modeling.
abstract: BACKGROUND
  Multidrug-resistant tuberculosis (MDR-TB) resulting from various factors has raised serious public health concerns worldwide. Identifying the ecological risk factors associated with MDR-TB is critical to its prevention and control. This study aimed to explore the association between the development of MDR-TB and the risk factors at the group-level (ecological risk factors) in China.
  
  
  METHODS
  Data on MDR-TB in 120 counties were obtained from the National Tuberculosis Information Management System, and data on risk-factor variables were extracted from the Health Statistical Yearbook, provincial databases, and the meteorological bureau of each province (municipality). Partial Least Square Path Modeling was used to detect the associations.
  
  
  RESULTS
  The median proportion of MDR-TB in new TB cases was 3.96% (range, 0-39.39%). Six latent factors were extracted from the ecological risk factors, which explained 27.60% of the total variance overall in the prevalence of MDR-TB. Based on the results of PLS-PM, TB prevention, health resources, health services, TB treatment, TB detection, geography and climate factors were all associated with the risk of MDR-TB, but socioeconomic factors were not significant.
  
  
  CONCLUSIONS
  The development of MDR-TB was influenced by TB prevention, health resources, health services, TB treatment, TB detection, geography and climate factors. Such information may help us to establish appropriate public health intervention strategies to prevent and control MDR-TB and yield benefits to the entire public health system in China.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China.
authors.forename: Yun-Xia
authors.initials: YX
authors.lastname: Liu
authors.affiliation: Institute Office, Shandong Academy of Medical Science, Jinan, China.
authors.forename: Chun-Kun
authors.initials: CK
authors.lastname: Pang
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China.
authors.forename: Yanxun
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China.
authors.forename: Xiu-Bin
authors.initials: XB
authors.lastname: Sun
authors.affiliation: Institute for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Xin-Xu
authors.initials: XX
authors.lastname: Li
authors.affiliation: Institute for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Shi-Wen
authors.initials: SW
authors.lastname: Jiang
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China.
authors.forename: Fuzhong
authors.initials: F
authors.lastname: Xue
mesh_terms: D002681:China / Q000453:epidemiology; D002980:Climate; D016208:Databases, Factual; D005843:Geography; D006801:Humans; D016018:Least-Squares Analysis; D015995:Prevalence; D012307:Risk Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology*; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*