{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:28:56Z","timestamp":1787027336451,"version":"build-2736575974"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"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>Tuberculosis (TB) remains the leading cause of death from a single infectious agent. However, there is limited quantitative evidence on the impact of urbanization on TB burden. We aimed to assess the relationship between urbanization and the global TB burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using multi-source data, we developed a composite index of urbanization across 178 countries and territories from 2012 to 2019, incorporating the proportion of urban population, the proportion of population using improved sanitation, nighttime light intensity, normalized difference vegetation index, and per capita gross domestic product. Fixed-effects linear models were applied to estimate the rate ratios (RRs) and 95% confidence intervals (CIs) for the association between urbanization and the incidence, prevalence, and mortality of total TB and three subtypes: drug-susceptible TB (DS-TB), multidrug-resistant TB (MDR-TB), and extensively drug-resistant TB (XDR-TB).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, higher urbanization scores were associated with significant reductions in the burden of MDR-TB and XDR-TB but showed no effect on total TB or DS-TB. For MDR-TB, each additional urbanization score was associated with a 1.0% decrease in incidence (RR\u202f=\u202f0.990; 95% CI: 0.985\u20130.996), a 1.1% decrease in prevalence (0.989; 0.984\u20130.994), and a 0.7% decrease in mortality (0.993; 0.988\u20130.998). For XDR-TB, the corresponding reductions were 0.9% in incidence (0.991; 0.986\u20130.996), 1.0% in prevalence (0.990; 0.985\u20130.995), and 0.7% in mortality (0.993; 0.988\u20130.998). These relationships persisted when considering a one-year lag in urbanization. In subgroup analyses, however, urbanization was associated with increased MDR-TB and XDR-TB burdens in upper-middle-income countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Urbanization was linked to reduced MDR-TB and XDR-TB burdens globally, but to increased burdens in upper-middle-income countries. Building well-managed and healthy cities is essential not only for sustainable urbanization but also for strengthening TB prevention and control, especially in rapidly transitioning upper-middle-income countries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1658814","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T05:38:38Z","timestamp":1757396318000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Disparities in the burden of tuberculosis associated with urbanization across 178 countries and territories: an observational study"],"prefix":"10.3389","volume":"13","author":[{"given":"Yaping","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiao","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongdan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanlin","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jue","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"key":"ref1","volume-title":"World cities report 2020: The value of sustainable urbanization","year":"2020"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1097\/yco.0000000000000588","article-title":"Urbanization, urbanicity, and depression: a review of the recent global literature","volume":"33","author":"Sampson","year":"2020","journal-title":"Curr Opin Psychiatry"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"122579","DOI":"10.1016\/j.envpol.2023.122579","article-title":"Association of land urbanization and type 2 diabetes mellitus prevalence and mediation of greenness and physical activity in Chinese adults","volume":"337","author":"Guan","year":"2023","journal-title":"Environ Pollut"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"906","DOI":"10.1007\/s11524-011-9586-1","article-title":"Quantifying urbanization as a risk factor for noncommunicable disease","volume":"88","author":"Allender","year":"2011","journal-title":"J Urban Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"107231","DOI":"10.1016\/j.envint.2022.107231","article-title":"Projections of future temperature-related cardiovascular mortality under climate change, urbanization and population aging in Beijing, China","volume":"163","author":"Xing","year":"2022","journal-title":"Environ Int"},{"key":"ref6","volume-title":"Global tuberculosis report 2024","year":"2024"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1642","DOI":"10.1016\/s0140-6736(19)30308-3","article-title":"Tuberculosis","volume":"393","author":"Furin","year":"2019","journal-title":"Lancet"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.cois.2019.06.002","article-title":"Complexity of the relationship between global warming and urbanization - an obscure future for predicting increases in vector-borne infectious diseases","volume":"35","author":"Wilke","year":"2019","journal-title":"Curr Opin Insect Sci"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e302","DOI":"10.1016\/s1473-3099(19)30161-6","article-title":"The effect of global change on mosquito-borne disease","volume":"19","author":"Franklinos","year":"2019","journal-title":"Lancet Infect Dis"},{"key":"ref10","year":"2021"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/s0140-6736(20)30925-9","article-title":"GBD 2019 Diseases and Injuries Collaborators. 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