{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:22:51Z","timestamp":1785435771318,"version":"3.56.0"},"reference-count":33,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100015539","name":"Australian Government","doi-asserted-by":"publisher","award":["HSS100"],"award-info":[{"award-number":["HSS100"]}],"id":[{"id":"10.13039\/100015539","id-type":"DOI","asserted-by":"publisher"}]},{"award":["HSS100"],"award-info":[{"award-number":["HSS100"]}],"id":[{"id":"https:\/\/ror.org\/0314h5y94","id-type":"ROR","asserted-by":"publisher"}]},{"name":"University of Pittsburgh School of Public Health"},{"id":[{"id":"https:\/\/ror.org\/01an3r305","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Tuberculosis (TB) remains a major public health burden in Vietnam, yet few studies have examined pulmonary TB mortality trends at sub-national levels, where local epidemiological patterns may differ substantially from national averages and reveal high-risk populations requiring targeted interventions and inform resource allocation. Lang Son, Vietnam, is a mountainous border province with many ethnic minority residents, and extensive cross-border movement creates distinct challenges for TB surveillance and treatment adherence. Although mortality has declined in line with national trends, rates in this border province remain higher than those in Vietnam\u2019s major urban centers. This disparity suggests a hidden burden where Lang Son\u2019s unique geographic challenges and ethnic diversity create health inequities that are often obscured by favorable national-level averages. To better understand local epidemiological patterns, this study examined temporal trends and gender differences in pulmonary TB mortality in Lang Son Province over a 12-year period (2005\u20132008 and 2011\u20132018). Using data from a population-based mortality registration system, we calculated crude and age-standardized mortality rates (ASR) per 100,000 person-years. Temporal trends were assessed using Poisson regression. The overall ASR was 7.7 per 100,000 person-years among men (95% CI: 6.5\u20139.0) and 1.9 among women (95% CI: 1.3\u20132.7), yielding a male-to-female ASR ratio of 4.1. The age-standardized pulmonary TB mortality declined by approximately 49.2% (from 6.3 (95% CI: 4.1\u20139.2) to 3.2 (95% CI: 1.9\u20134.9) per 100,000 person-years; p = 0.025). Notably, 69.9% of deaths occurred in individuals under age 70. While declines were observed in both sexes, sex-specific temporal trends were not statistically significant (p &gt; 0.05). Despite these improvements, persistently higher mortality among men and older adults highlights ongoing inequities in TB outcomes within the province. These pre-pandemic findings provide an essential epidemiological baseline for assessing COVID-19\u2019s impact on TB control and underscore the need for age- and gender-targeted interventions at sub-national levels to accelerate Vietnam\u2019s progress toward TB elimination.<\/jats:p>","DOI":"10.3390\/tropicalmed11040099","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T09:08:12Z","timestamp":1775812092000},"page":"99","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trends in Pulmonary Tuberculosis Mortality: A Population-Based Study in a Northern Vietnamese Province, 2005\u20132008 and 2011\u20132018"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7862-492X","authenticated-orcid":false,"given":"Ngoan Tran","family":"Le","sequence":"first","affiliation":[{"name":"Department of Health Management, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ngan Dieu Thi","family":"Ta","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Hanoi Medical University, Hanoi 100000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quyet Quang","family":"Nguyen","sequence":"additional","affiliation":[{"name":"CDC Lang Son, Lang Son City 240000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanh C.","family":"Bui","sequence":"additional","affiliation":[{"name":"Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Campus, Oklahoma City, OK 73104, USA"},{"name":"TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua T.","family":"Mattila","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA"},{"name":"Center for Vaccine Research, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8640-254X","authenticated-orcid":false,"given":"Suresh V.","family":"Kuchipudi","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA"},{"name":"Center for Vaccine Research, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA"},{"name":"Department of Microbiology and Molecular Genetics, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0574-0804","authenticated-orcid":false,"given":"Toan","family":"Ha","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA"},{"name":"Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT 06030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2025). Global Tuberculosis Report 2025, WHO. Available online: https:\/\/www.who.int\/teams\/global-programme-on-tuberculosis-and-lung-health\/tb-reports\/global-tuberculosis-report-2025."},{"key":"ref_2","unstructured":"World Health Organization (2024). Tuberculosis Resurges as Top Infectious Disease Killer, WHO. Available online: https:\/\/www.who.int\/news\/item\/29-10-2024-tuberculosis-resurges-as-top-infectious-disease-killer."},{"key":"ref_3","unstructured":"World Health Organization (2020). Global Tuberculosis Report 2020, WHO. Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/329368\/9789241565714-eng.pdf?ua=1."},{"key":"ref_4","first-page":"151","article-title":"Establishment and development of the National Tuberculosis Control Programme in Vietnam","volume":"9","author":"Huong","year":"2005","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_5","unstructured":"Hoa, N.P. (2004). Tuberculosis Control in Vietnam: Directly Observed Treatment, Short-Course (DOTS): The Role of Information and Education. [Ph.D. Thesis, Karolinska Institutet]. Available online: https:\/\/hdl.handle.net\/10616\/43355."},{"key":"ref_6","unstructured":"Statista (2025, February 05). Number of Deaths from Tuberculosis per 100,000 Population in Vietnam from 2005 to 2021. Available online: https:\/\/www.statista.com\/statistics\/689804\/vietnam-deaths-from-tuberculosis\/."},{"key":"ref_7","unstructured":"VietnamNet (2025, February 05). Tuberculosis Kills over 11,000 Vietnamese Annually, Health Experts Urge Action. Available online: https:\/\/vietnamnet.vn\/en\/tuberculosis-kills-over-11-000-vietnamese-annually-health-experts-urge-action-2383911.html."},{"key":"ref_8","unstructured":"Stop TB Partnership (2026, April 02). Vietnam Country Assessment\u2014TB Surveillance and Digital Tools. Available online: https:\/\/tbassessment.stoptb.org\/vietnam.html."},{"key":"ref_9","unstructured":"Vietnamplus (2025, May 05). Vietnam Ramps Up Efforts to Eradicate Tuberculosis by 2035. Available online: https:\/\/en.vietnamplus.vn\/vietnam-ramps-up-efforts-to-eradicate-tuberculosis-by-2035-post318095.vnp."},{"key":"ref_10","unstructured":"B\u00e1o L\u1ea1ng S\u01a1n (2026, February 03). Ethnic Minorities in Lang Son Unite, Innovate, Integrate and Develop Sustainably. Available online: https:\/\/baolangson.vn\/en\/ethnic-minorities-in-lang-son-unite-innovate-integrate-and-develop-sustainably-5029104.html."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"499","DOI":"10.3201\/eid3003.231309","article-title":"Spatial analysis of drug-susceptible and multidrug-resistant cases of tuberculosis, Ho Chi Minh City, Vietnam, 2020\u20132023","volume":"30","author":"Spies","year":"2024","journal-title":"Emerg. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"872","DOI":"10.3201\/eid2703.204253","article-title":"Decline of tuberculosis burden in Vietnam measured by consecutive national surveys, 2007\u20132017","volume":"27","author":"Nguyen","year":"2021","journal-title":"Emerg. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Nguyen, H.V., Tiemersma, E.W., Nguyen, H.B., Cobelens, F.G.J., Finlay, A., Glaziou, P., Dao, C.H., Mirtskhulava, V., Nguyen, H.V., and Pham, H.T.T. (2020). The second national tuberculosis prevalence survey in Vietnam. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0236532"},{"key":"ref_14","first-page":"7","article-title":"Tuberculosis case notification data in Viet Nam, 2007 to 2012","volume":"6","author":"Nhung","year":"2015","journal-title":"West. Pac. Surveill. Response J."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Vree, M., Hoa, N.B., Sy, D.N., Co, N.V., Cobelens, F.G., and Borgdorff, M.W. (2007). Low tuberculosis notification in mountainous Vietnam is not due to low case detection: A cross-sectional survey. BMC Infect. Dis., 7.","DOI":"10.1186\/1471-2334-7-109"},{"key":"ref_16","unstructured":"World Bank (2024). Cause of Death, by Communicable Diseases and Maternal, Prenatal and Nutrition Conditions (% of Total)\u2014Vietnam, World Bank. Available online: https:\/\/data.worldbank.org\/indicator\/SH.DTH.COMM.ZS?locations=VN."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1177\/1010539515602742","article-title":"Evaluation of the Vietnamese A6 mortality reporting system: All-cause mortality","volume":"27","author":"Stevenson","year":"2015","journal-title":"Asia Pac. J. Public Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1136\/injuryprev-2011-040261","article-title":"Evaluation of the Vietnamese A6 mortality reporting system: Injury as a cause of death","volume":"18","author":"Stevenson","year":"2012","journal-title":"Inj. Prev."},{"key":"ref_19","unstructured":"General Statistics Office (2026, February 03). Completed Results of the 2019 Viet Nam Population and Housing Census, Available online: https:\/\/www.nso.gov.vn\/en\/data-and-statistics\/2020\/11\/completed-results-of-the-2019-viet-nam-population-and-housing-census\/."},{"key":"ref_20","unstructured":"Ahmad, O.B., Boschi Pinto, C., and Lopez, A.D. (2001). Age Standardization of Rates: A New WHO Standard, WHO. GPE Discussion Paper Series No. 31."},{"key":"ref_21","unstructured":"United Nations (2026, February 17). Sustainable Development Goal 3, Target 3.4. Available online: https:\/\/sdgs.un.org\/goals\/goal3."},{"key":"ref_22","unstructured":"World Health Organization (2018). SDG Indicator 3.4.1 Metadata, WHO. Available online: https:\/\/www.who.int\/data\/gho\/indicator-metadata-registry\/imr-details\/3354."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2271","DOI":"10.1016\/S0140-6736(24)02417-6","article-title":"Halving premature death and improving quality of life at all ages","volume":"404","author":"Norheim","year":"2024","journal-title":"Lancet"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"967","DOI":"10.3201\/eid2905.221476","article-title":"Influence of sex and sex-based disparities on prevalent tuberculosis, Vietnam, 2017\u20132018","volume":"29","author":"Nguyen","year":"2023","journal-title":"Emerg. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Sun, R., Wang, L., and Xia, H. (2024). Disease burden of tuberculosis in China from 1990 to 2021 and its prediction to 2036. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1506266"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"46","DOI":"10.4103\/0970-2113.48897","article-title":"Tuberculosis and patient gender: An analysis and its implications in tuberculosis control","volume":"26","author":"Rao","year":"2009","journal-title":"Lung India"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Chumchuen, K., and Chongsuvivatwong, V. (2024). Increased active pulmonary tuberculosis risk from sharing bong of cannabis: A case-control study from Thailand. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1474761"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"107966","DOI":"10.1016\/j.ijid.2025.107966","article-title":"Global burden of tuberculosis among adults aged 60 years and older, 1990\u20132021: Findings from the Global Burden of Disease Study 2021","volume":"158","author":"Liu","year":"2025","journal-title":"Int. J. Infect. Dis."},{"key":"ref_29","unstructured":"GBD 2021 Tuberculosis Collaborators (2024). Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: A systematic analysis for the Global Burden of Disease Study 2021. Lancet Infect. Dis., 24, 698\u2013725."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Foster, N., Nguyen, H.V., Nguyen, N.V., Nguyen, H.B., Tiemersma, E.W., Cobelens, F.G.J., Quaife, M., and Houben, R.M.G.J. (2022). Social determinants of the changing tuberculosis prevalence in Vietnam: Analysis of population-level cross-sectional studies. PLoS Med., 19.","DOI":"10.1371\/journal.pmed.1003935"},{"key":"ref_31","unstructured":"Vietnam News Agency (2026, January 26). Cross Border Tourism, Trade Rebound at Huu Nghi Int\u2019l Border Gate. Available online: https:\/\/vietnam.vnanet.vn\/english\/tin-van\/cross-border-tourism-trade-rebound-at-huu-nghi-intl-border-gate-402250.html."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Tang, Y., Zhao, M., Wang, Y., Gong, Y., Yin, X., Zhao, A., Zheng, J., Liu, Z., Jian, X., and Wang, W. (2015). Non-adherence to anti-tuberculosis treatment among internal migrants with pulmonary tuberculosis in Shenzhen, China: A cross-sectional study. BMC Public Health, 15.","DOI":"10.1186\/s12889-015-1789-z"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2033","DOI":"10.1016\/j.cmi.2025.08.020","article-title":"Team-based, hybrid, or standard of care? Organizational models of tuberculosis care on tuberculosis outcomes in eleven Italian hospitals","volume":"31","author":"Guido","year":"2025","journal-title":"Clin. Microbiol. Infect."}],"container-title":["Tropical Medicine and Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-6366\/11\/4\/99\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T09:55:00Z","timestamp":1775814900000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-6366\/11\/4\/99"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,10]]},"references-count":33,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["tropicalmed11040099"],"URL":"https:\/\/doi.org\/10.3390\/tropicalmed11040099","relation":{},"ISSN":["2414-6366"],"issn-type":[{"value":"2414-6366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,10]]}}}