Context
Tuberculosis remains one of the leading causes of mortality worldwide, with Romania ranking among the European Union countries with the highest incidence rates. More than 8,000 new cases are reported annually, highlighting the endemic nature of the disease. The spatial distribution of tuberculosis incidence exhibits significant territorial variations influenced by socioeconomic, demographic, and environmental factors. The study published by Peptenatu et al. (2024) in GeoHealth aims to analyze the spatiotemporal patterns of tuberculosis cases in Romania and investigate their correlations with fine particulate matter (PM2.5) air pollution.
Main Objectives
The main objectives of the study were to:
Identify the spatial and temporal patterns of tuberculosis incidence at the level of administrative-territorial units.
Analyze the impact of the COVID-19 pandemic on the dynamics of reported cases.
Assess the correlations between tuberculosis incidence and PM2.5 air pollution levels.
Identify territorial risk clusters to support the development of public health policies tailored to local conditions.
Methodology
The analysis was conducted across all administrative-territorial units in Romania, using the national database of the Tuberculosis Prevention, Surveillance and Control Programme for the period 2012–2021. Demographic data, stratified by age and sex, were correlated with data on new tuberculosis cases and relapses, expressed relative to the total population.
For the pollution component, PM2.5 data from the van Donkelaar et al. (2021) database were integrated. The methodology included spatial analysis techniques, such as global and local spatial autocorrelation and Moran’s I statistics, implemented using the PySAL statistical package and QGIS. A spatial weighting matrix based on territorial contiguity was employed.
In parallel, statistical tests of independence, including the Chi-square test and Cramér’s V, were applied to assess the strength of the association between tuberculosis incidence and PM2.5 pollution.
Results
The results revealed an average annual decline in tuberculosis cases of −5.7% between 2012 and 2019, followed by an abrupt reduction of approximately 30% during the COVID-19 pandemic (2020–2021). This decline was primarily attributed to disruptions in healthcare services and the underreporting of cases.
The spatial analysis identified 327 administrative-territorial units classified as high-incidence clusters, or hotspots, and 477 classified as low-incidence clusters, or coldspots. The most affected regions were Oltenia, southern Moldova, and the Danube Delta.
From a sociodemographic perspective, men aged 30–55 exhibited the highest incidence rates, with a ratio of up to 7:1 compared with women in the 50-year-old age group. Individuals aged 16–23 were more susceptible to extrapulmonary forms of tuberculosis.
The spatial correlation analysis confirmed a significant association between tuberculosis incidence and elevated PM2.5 concentrations in urbanized and industrialized areas, including Bucharest, Timișoara, and Iași.
Implications
The correlation between elevated pollution levels and increased tuberculosis incidence highlights the importance of implementing integrated health policies that address both medical and environmental determinants. The findings suggest the need for active screening programmes in high-risk clusters, as well as improvements in healthcare infrastructure in socioeconomically disadvantaged areas.
The study demonstrates that spatial analysis is an essential tool for allocating resources effectively and developing public policies tailored to local conditions.
Conclusion
The study confirms that the distribution of tuberculosis in Romania is strongly influenced by spatial, socioeconomic, and environmental factors. Identifying risk clusters and examining their association with air pollution provide a better understanding of the determinants of the disease and offer a solid foundation for developing effective public health policies.
Furthermore, the findings may contribute to the development of replicable methodologies for other countries with a high tuberculosis burden, thereby strengthening global efforts to control the disease and reduce its impact.