Determinants of tuberculosis incidence in East Asia and Pacific: A panel regression analysis

Background and Methodology: Tuberculosis (TB) remains one of the world’s deadliest communicable diseases. To circumvent surges of TB cases, several studies have been carried out analyzing the determinants of TB incidence and recommended policy measures based on the significant indicators. Although the determinants were suggested for strategic planning of TB, the implementation of new measures was either unsuccessful or difficult to realize because of logistical, administrative, and financial constraints. This ecological multinational-based study aims to unravel potential determinants of TB incidence across 23 countries in East Asia and Pacific for a five year-period (2010-2014). Carbon dioxide emission, PM2.5 air pollution exposure, unemployment (percent of total labor force), percent of people using at least basic sanitation services, percent of people practicing open defecation, health expenditure (percent of GDP), and out-of-pocket health expenditure are included as the determinants of TB incidence. The disentangling of possible association between variables was carried out using panel regression analysis. Findings: For every one unit increase in microgram per cubic meter of PM2.5 pollution, in the unemployment percentage of total labor force, and in the percentage of out-of-pocket health expenditure, the rate of TB cases per 100,000 population was predicted to be 4.617, 13.504, and 3.467 higher, respectively, holding other variables constant. On the other hand, for every one unit increase in the kiloton of CO2 emission and in the percent of people using at least basic sanitation services, the rate of TB cases per 100,000 population was predicted to be 0.00003828 and 4.457 lower, respectively. Percent of people practicing open defecation and health expenditure (percent of GDP) did not significantly influence TB incidence. Interpretation: The study suggests how an increase in unemployment consequently increases TB incidence across the countries. Proper implementation of programs that could promote proper hygiene is essential to increase adherence of people to basic sanitation practices. Based on the study, this is an important factor in mitigating higher incidence of TB. Therefore, strategies may be formulated to either maintain or improve this determinant in order to significantly reduce TB cases. Finally, concerted efforts may be developed to decrease emission of hazardous finer particles from residential, industrial, and agricultural burning, in order to control tuberculosis.