ORIGINAL RESEARCH article
Front. Cell. Infect. Microbiol.
Sec. Bacteria and Host
Volume 15 - 2025 | doi: 10.3389/fcimb.2025.1651920
This article is part of the Research TopicFactors for the Progression from Latent Tuberculosis Infection to Tuberculosis Disease Volume IIView all articles
Epidemiological features of Tuberculosis Infection in a high-altitude population: a population-based, cross-sectional survey in Tibet, China
Provisionally accepted
Jian Wang1
Shaojun Pei2
Guofeng Yang1Nima Qucuo1Qifei Song1Xiaoqiu Liu3Xue Li3
Wei Chen3
Tao Li3Eryong Liu3
Xichao Ou3Hui Chen3Ni Ni3Jingjuan Ren3
Yanlin Zhao3*Hongqiang Gong1*- 1Centre for Disease Control and Prevention of Tibetan Autonomous Region, Tibet, China
- 2Peking University, Beijing, China
- 3Chinese Center for Disease Control and Prevention, Beijing, China
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Background: Targeted strategies for marginalized populations, including high-altitude communities, are crucial for TB elimination. This study assessed TB infection (TBI) prevalence across altitudinal gradients and evaluated altitude-dependent risk factors in Tibet, China.A cross-sectional survey by multistage stratified random cluster sampling was conducted using ESAT6-CFP10 skin test (C-TST), symptom screening, chest Xrays, and bacteriological tests. The influencing factors of C-TST positivity were analyzed via generalized linear mixed models (GLMMs) and Boruta algorithm feature ranking. The TBI prevalence was estimated using WHO-recommended methods.Causal mediation analysis was performed to explore mediating variables contributing to association between altitude and TBI prevalence.The estimated TBI prevalence in Tibet was 20.7% (95% CI 14.3%-33.0%).Residential altitude was the strongest predictor of EC positivity (aOR=0.53, p<0.001).The interaction analyses revealed significant modification effects of both smoking status (interaction p=0.0065) and BCG vaccination (interaction p=0.028) on the altitude-C-TST positivity association. Mediation analysis indicated that the observed inverse relationship between study site altitude and crude TBI prevalence was mediated by per capita land space (IE= -6.29e-05, p=0.04). The prevalence of TBI in very highaltitude (VHA) ares was 12.8%, approximately one-third of that in high-altitude (HA) areas (35.0%). Stratified analyses revealed distinct risk profiles -occupational exposures predominated in HA regions, whereas physiological factors (age, BMI, smoking) drove positivity in VHA areas.Our results suggest that TB infection is significantly associated with altitude, necessitating accelerated research into plateau-specific disease mechanisms and the development of targeted public health strategies tailored to local socio-medical conditions. This integrated biological and socio-economic approach is essential to overcome the compounded vulnerabilities of high-altitude populations and ensure that China equitably achieves its goal of eliminating TB.
Keywords: Tuberculosis infection, high altitude, very high altitude, Tibet, EC skin test
Received: 22 Jun 2025; Accepted: 12 Aug 2025.
Copyright: © 2025 Wang, Pei, Yang, Qucuo, Song, Liu, Li, Chen, Li, Liu, Ou, Chen, Ni, Ren, Zhao and Gong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Yanlin Zhao, Chinese Center for Disease Control and Prevention, Beijing, China
Hongqiang Gong, Centre for Disease Control and Prevention of Tibetan Autonomous Region, Tibet, China
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