Changes in the epidemic of pulmonary tuberculosis in Shanghai from 1992 to 2016

To estimate whether WHO's End TB Strategy targets can be achieved by analysing the incidence trend of pulmonary tuberculosis in Shanghai during 1992-2016.

The age-adjusted annual incidence of tuberculosis (TB) was calculated based on data from the national TB registration system. Linear regression was applied to analyse the trend of the epidemic, together with the statistical indicator of annual percent change (APC).

The overall age-standardised rate decreased from 34.8/100 000 in 1992 to 21.2/100 000 in 2016, or by 2.15% (t = -13.258, P < 0.05) annually. After rapidly declining between 1999 and 2003 (-5.4% p.a.), the epidemic remained at a stable level with a lower annual declining rate (-1.1% p.a). In 2035, the estimated incidence will be 17.2/100 000 based on the APC in 2004-2016. There were two peaks in average incidence of the total population, 30.9/100 000 in the 20-24 age group and 66.4/100 000 in the 70-74 age group. Overall, the ratio of new to retreated cases continually rose and eventually reached 8.36:1 in 2016. The constituent ratio of smear-positive cases ranged from 35.9% to 47.8% without rising or decreasing trend (P = 0.065).

The epidemic of TB in Shanghai has steadily declined during last two decades. A new strategy should be developed to rapidly reduce the incidence rate to achieve the WHO Goals in 2035.