Trends in epidemiological characteristics of pulmonary tuberculosis among children and youth in Chinese mainland from 2019 to 2024: analysis of national surveillance data.

BACKGROUND: This study aims to analyze trends in epidemiological characteristics of pulmonary tuberculosis (PTB) among children and youth in mainland China from 2019 to 2024 to support informed policy decisions for TB care and prevention. METHODS: Data on notified PTB cases were extracted from the National TB Surveillance System along with population information for each province from 2019 to 2024. Age-standardized incidence rate (ASIR) was estimated and stratified by year, age, gender and province. Descriptive analysis examined patient characteristics. The Kruskal-Wallis H and Chi-square tests compared data across years. Temporal trends were analyzed using Joinpoint regression models. The average annual percent change (AAPC) assessed the overall trend, and the annual percent change (APC) evaluated local trend or overall trend when there was no joinpoint (APC = AAPC). Spatial-temporal patterns were explored through spatial autocorrelation analysis and spatial-temporal scan statistics. RESULTS: From 2019 to 2024, mainland China reported 419,000 new PTB cases, with 90.6% in youth and 9.4% in children. The majority were students (48.3%) and farmers (23.8%). The proportion of ethnic minorities, students, individuals identified through active case finding, drug-resistant TB cases, and those with positive bacteriological tests increased over time. Males outnumbered females, but between ages 9 and 15, females surpassed males. The male-to-female ratio remained stable in children, while in youth, males were consistently more affected. The average ASIR over six years was 17.2 per 100,000. Joinpoint regression showed a significant decrease in ASIR from 24.7 per 100,000 in 2019 to 10.5 per 100,000 in 2024 (AAPC = - 15.98, P < 0.0001), with no significant joinpoints. Seasonal peak occurred in late spring and autumn, with a trough in February each year. High PTB clusters persisted in the southwest and northwest, particularly in the southwest, where cases increased. Most provinces showed a decline in ASIR, with the most significant decrease in Xinjiang, while Tibet and Qinghai experienced slower reductions. CONCLUSION: China has made progress in reducing PTB cases among children and youth. However, disparities remain, particularly in high-risk regions. Targeted interventions addressing social and structural factors, along with enhanced regional monitoring and public health measures, are essential to further reduce incidence.