Effects of human mobility on tuberculosis incidence in mainland China, 2010–2023: an ecological analysis and metapopulation modeling study

Human mobility plays an important role in the transmission of infectious diseases, yet its contribution to tuberculosis (TB) dynamics in China remains insufficiently quantified. We compiled a province-year panel for mainland China (2010–2023) to describe spatiotemporal trends using relative percentage change and estimated annual percentage change (EAPC), and fitted generalized linear mixed models to relate passenger turnover to TB incidence rates. To capture cross-regional transmission, we developed a three-region metapopulation model parameterized with monthly data (June 2018-December 2020) and ran scenarios reducing inter-regional flows. National TB incident cases declined from 991,350 to 613,091 (-38.2%); incidence rates fell from 74.27 to 43.49 per 100,000 (EAPC − 4.45, 95% CI -5.27 to -3.63). Passenger turnover was positively correlated with TB incidence rates nationwide (IRR 1.01, 95% CI 1.00-1.02, P = 0.005), corresponding to an 8.55% higher incidence rate per interquartile-range increase. Positive correlations were also observed in the eastern and central regions, while no significant relationship was found in the western region. Flow-reduction scenarios yielded modest national declines (e.g., -0.09% at 50% reduction; -0.70% with no flow) but pronounced heterogeneity: incidence decreased in the eastern region (-0.98% at 50% reduction; -3.52% with no flow) and central region (-1.53%; -10.39%), yet increased in the western region (+ 2.06%; +10.89%). Human mobility showed a positive correlation with TB incidence in mainland China, and mechanistic modeling suggested that its impacts varied substantially across regions. Mobility-aware, region-tailored strategies could reduce TB burden and narrow east-west disparities.