Prevalence of non-tuberculous mycobacterial pulmonary diseases among TB cases in China using random forest socioeconomic factors

Non-tuberculous mycobacteria (NTM) cause pulmonary diseases that resemble tuberculosis and are frequently misdiagnosed in TB-endemic settings, leading to inappropriate treatment. This study aimed to determine the prevalence of NTM pulmonary disease (NTMPD) among patients presumed to have pulmonary TB in China, and to evaluate the impact of ecological, climatic, and socioeconomic factors on NTMPD identification. Data on notification cases between January 1, 2011 and December 31, 2020 were from the National TB Information Management System (TBIMS). Joinpoint regression models were used to analyze temporal trends in NTMPD prevalence and its spatial variability. A random forest model was employed to assess the effects of ecological, climatic, and socioeconomic factors on NTMPD identification. NTMPD cases are concentrated primarily in the eastern and southeastern coastal regions of China. NTMPD prevalence shows an annual decline (AAPC = −1.64%, 95% CI: −2.76% to −0.51%). Random forest analysis identifies annual average temperature (mean importance = 5.51%, 95% CI: 3.50% to 7.53%), GDP (mean importance = 3.60%, 95% CI: 2.19% to 5.01%), and water coverage area (mean importance = 3.45%, 95% CI: 1.73% to 5.16%) as key predictors of NTMPD identification. In 2020, 573 counties remain classified as neglected high-risk areas. NTMPD in China exhibits spatial heterogeneity and a declining temporal trend, with identification influenced by ecological, climatic, and socioeconomic factors. These findings highlight the need for targeted surveillance and diagnostic capacity strengthening, particularly in neglected high-risk areas. Non-tuberculous mycobacteria can cause lung diseases similar to Mycobacterium tuberculosis and are often misdiagnosed in tuberculosis-endemic settings, leading to inappropriate treatment and delayed care. Understanding how common non-tuberculous mycobacteria pulmonary disease (NTMPD) is, and where it is concentrated, is important for improving diagnosis and patient management. We examined NTMPD among patients initially presumed to have pulmonary tuberculosis across China. We found that environmental, climatic, and socioeconomic factors were associated with NTMPD identification, and more than 500 counties remained classified as neglected high-risk areas. Li et al., use national surveillance data from 2011–2020, for analysis of trends and geographic patterns of non-tuberculous mycobacterial pulmonary disease (NTMPD) in China and assess ecological, climatic, and socioeconomic factors linked to its identification. NTMPD is concentrated in eastern and southeastern China, declines over time, and is most strongly associated with temperature, GDP, and water coverage, with 573 counties remaining neglected high-risk areas in 2020.