Incidence of Tuberculosis in Mountain Areas and Surrounding Townships: Dose–Response Relationship by Geographic Analysis

Purpose The incidence of tuberculosis (TB) in Taiwan is known to be high in aboriginal mountain areas and low in the surrounding non-mountain areas. The aim of this study was to assess whether TB incident cases in the surroundings of mountain areas decreased with distance from foci of mountain areas. Methods The mountain areas in Taiwan are adjacent to each other and divided into four geographic groups. Townships with high TB incidence in each group were treated as the foci of TB infection. The surrounding townships were then classified, by distance away from foci, into three levels: < 20 km, 20 to 40 km, and 40 to 60 km. Data were obtained on a total of 84,366 TB cases from 1991 to 1997 from the Taiwan Tuberculous Disease Registry Center. Results The incidence of TB in each of the four groups was significantly higher in the mountain areas compared with non-mountain areas, with relative risks ranging from 8.4 (95% confidence interval [CI], 7.8–9.1) for the southern group to 15.0 (95% CI, 13.4–16.9) for the northern group. Relative risks for surrounding townships decreased with distance in all four groups. Such a gradient relationship was statistically significant. Conclusions A significant dose–response relationship between distance from townships with a high incidence of TB and the incidence of TB in the surrounding areas has been demonstrated.