title: Spatial and temporal analysis of tuberculosis in Zhejiang Province, China, 2009-2012.
abstract: BACKGROUND
  Tuberculosis (TB) is an infectious disease of major public health concern. The disease has demonstrated large space-time variations. This study aims to explore the space-time dynamics of TB cases in an economically and geographically dynamic province in China with specific references of TB control for policy makers.
  
  
  METHODS
  Data on all reported TB cases from 2009 to 2012 were collected from the TB program at the Zhejiang Provincial Center for Disease Control and Prevention. We employed time series and exploratory spatial data analyses, including Moran's I, Local Getis's G i (*) , and Kulldorff's space-time scan statistics, to identify the temporal trends and spatial patterns of TB at a county level.
  
  
  RESULTS
  A total of 147,941 TB cases were reported during 2009-2012 in Zhejiang. A higher proportion of TB cases were younger, male, and registered permanent residents among all TB cases notified in the province. TB cases were reported most frequently in April with small peaks in June, July, and October. This disease was spatially clustering with Moran's I values ranged from 0.29 to 0.32 (p < 0.001). A most likely cluster and ten secondary clusters were identified, mainly concentrated in the southeast and west counties of the province.
  
  
  CONCLUSIONS
  This study identified seasonal patterns and significant space-time clusters of TB cases in Zhejiang, China. Poverty, migration, and seasonal effects may play important roles in potential clusters.
authors.affiliation: School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, S.A.R., China. geerjia@gmail.com.
authors.forename: Erjia
authors.initials: E
authors.lastname: Ge
authors.affiliation: The Chinese University of Hong Kong, Shenzhen Research Institute, Shenzhen, China. Heaxzhan@icloud.com.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.affiliation: TB Program, Zhejiang Centre for Disease Control and Prevention, No. 630 Xincheng Road, Binjiang District, Hangzhou, Zhejiang, 310051, China. xmwang@cdc.zj.cn.
authors.forename: Xiaomeng
authors.initials: X
authors.lastname: Wang
authors.affiliation: JC School of Public Health, The Chinese University of Hong Kong, 2/F, School of Public Health, Prince of Wales Hospital, Shatin, Hong Kong, China. xiaolinwei@cuhk.edu.hk.|Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3 M7, Canada. xiaolinwei@cuhk.edu.hk.
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Wei
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012621:Seasons; D062211:Spatio-Temporal Analysis; D014376:Tuberculosis / Q000453:epidemiology*; D055815:Young Adult