{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:53:06Z","timestamp":1791615186233,"version":"4.3.4"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>China\u2019s aging population poses a growing challenge to disease burden. This study aims to evaluate the impact of population aging on the incidence of pulmonary tuberculosis (PTB) in Zhejiang Province, China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PTB notified incidence data reported to the National Notifiable Diseases Reporting System from 2005 to 2022 were analyzed. The notified incidence from 2023 to 2035 was estimated using exponential regression models. The decomposition algorithm was applied to decompose and quantify the effects of population aging, population growth, and age-specific incidence on the PTB incidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between 2005 and 2022, the notified incidence of PTB in Zhejiang Province declined from 93.5 per 100,000 to 33.99 per 100,000. The highest notified incidence was observed in those aged 60\u202fyears and older, with the population attributable fraction increasing from 18.76 to 27.92%. During this period, PTB cases decreased by 51.22% compared to 2005, driven by a 23.83% increase due to population growth, a 10.26% increase due to age structure, and an 85.31% decrease due to age-specific incidence. The contribution of age structure to the increase in the number of cases was \u22121.92, \u22121.69%, 3.28, and 10.60% in the age groups 0\u201319, 20\u201339, 40\u201359, and \u226560\u202fyears, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Notified incidence of PTB in Zhejiang Province is expected to decrease. However, this decrease may be affected by demographic changes, particularly in older adults. Thus, strengthening public health measures and policies is crucial to achieving the End TB Strategy goal by 2035, emphasizing the need to enhance PTB screening in older adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1647139","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T06:30:14Z","timestamp":1761719414000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Effect of population aging on pulmonary tuberculosis burden in Zhejiang Province, China: a population-based study"],"prefix":"10.3389","volume":"13","author":[{"given":"Yuxiao","family":"Ling","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songhua","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyi","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kui","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiqing","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianmin","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"key":"ref1","article-title":"Global tuberculosis report 2024","year":"2024"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1016\/j.idc.2010.04.011","article-title":"Tuberculosis in the global aging population","volume":"24","author":"Mori","year":"2010","journal-title":"Infect Dis Clin N Am"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1563","DOI":"10.1183\/13993003.01245-2015","article-title":"Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries","volume":"46","author":"Getahun","year":"2015","journal-title":"Eur Respir J"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"ofac575","DOI":"10.1093\/ofid\/ofac575","article-title":"Tuberculosis disease among adults aged 65 years and older: Alameda County, California, 2016-2019","volume":"9","author":"Wu","year":"2022","journal-title":"Open Forum Infect Dis"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1111\/resp.13303","article-title":"Epidemiological, clinical and mechanistic perspectives of tuberculosis in older people","volume":"23","author":"Yew","year":"2018","journal-title":"Respirology"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1378\/chest.116.4.961","article-title":"Does aging modify pulmonary tuberculosis?: A meta-analytical review","volume":"116","author":"Perez-Guzman","year":"1999","journal-title":"Chest"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1186\/s12879-016-1451-0","article-title":"Does tuberculosis threaten our ageing populations?","volume":"16","author":"Byng-Maddick","year":"2016","journal-title":"BMC Infect Dis"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2057","DOI":"10.1016\/S0140-6736(13)62639-2","article-title":"Tuberculosis prevalence in China, 1990-2010; 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N. The ageing of populations and its economic and social implications","year":"1956"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e0216613","DOI":"10.1371\/journal.pone.0216613","article-title":"A new method to attribute differences in total deaths between groups to population size, age structure and age-specific mortality rate","volume":"14","author":"Cheng","year":"2019","journal-title":"PLoS One"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1186\/s12879-020-4914-2","article-title":"Explaining age disparities in tuberculosis burden in Taiwan: a modelling study","volume":"20","author":"Fu","year":"2020","journal-title":"BMC Infect Dis"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e215302","DOI":"10.1001\/jamanetworkopen.2021.5302","article-title":"Changes in incidence and epidemiological characteristics of pulmonary tuberculosis in mainland China, 2005-2016","volume":"4","author":"Jiang","year":"2021","journal-title":"JAMA Netw 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1990-2000","volume":"72","author":"Dolin","year":"1994","journal-title":"Bull World Health Organ"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"E3238","DOI":"10.1073\/pnas.1720606115","article-title":"Data-driven model for the assessment of Mycobacterium tuberculosis transmission in evolving demographic structures","volume":"115","author":"Arregui","year":"2018","journal-title":"Proc Natl Acad Sci USA"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1192","DOI":"10.3390\/ijerph14101192","article-title":"Analysis of transmission and control of tuberculosis in mainland China, 2005-2016, based on the age-structure mathematical model","volume":"14","author":"Zhao","year":"2017","journal-title":"Int J Environ Res Public Health"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.1093\/cid\/cit027","article-title":"Prevention of tuberculosis in older adults in the United States: obstacles and 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