title: Spatial epidemiology and risk factors of pulmonary tuberculosis morbidity in Wenchuan earthquake-stricken area.
abstract: OBJECTIVE
  China is a country that experiences frequent earthquakes and has a high pulmonary tuberculosis burden. In this study, we aimed to explore the spatial clustering and risk factors of the reported incidence of pulmonary tuberculosis burden before and after the Wenchuan earthquake.
  
  
  METHODS
  Data on the location and the demographic, socioeconomic, and health service characteristics of the 181 counties of Sichuan province from 2004 to 2012 were collected. Global and local spatial autocorrelation analyses were performed to explore spatial clustering. The associated factors were screened using stepwise multiple linear regression, and a spatial lag model was fitted to explore the influence factors.
  
  
  RESULTS
  The incidence of pulmonary tuberculosis burden showed a global and local spatial autocorrelation relationship. The high-incidence counties shifted gradually over time from east to west and finally clustered in the "Aba-Ganzi" region. Factors influencing the incidence of pulmonary tuberculosis burden included minority areas, the proportion of the working population, county latitude, and the severity of the earthquake. The influence factors varied over time; the impact of minority regions, occupation, and health resources allocation weakened, whereas the economic development and mobility of the population became more significant.
  
  
  CONCLUSIONS
  The spatial structural relationship is an important factor related to pulmonary tuberculosis burden incidence. More attention should be paid to high-incidence areas and populations susceptible to pulmonary tuberculosis burden.
authors.affiliation: West China School of Public Health, Sichuan University, Chengdu, China.
authors.forename: Hailong
authors.initials: H
authors.lastname: Zhou
authors.affiliation: West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Yang
authors.affiliation: School of Finance and Statistics, Hunan University, Changsha, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Zhao
authors.affiliation: West China School of Public Health, Sichuan University, Chengdu, China.|National Center for Women and Children's Health, China CDC, Beijing, China.
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Pan
authors.affiliation: Sichuan Provincial Center for Disease Prevention and Control, Chengdu, China.
authors.forename: Junhong
authors.initials: J
authors.lastname: Xu
keywords: Wenchuan earthquake
  ; pulmonary tuberculosis; spatial lag model