Regional transport and its association with tuberculosis in the Shandong province of China, 2009–2011

• The emergence and transmission of tuberculosis (TB) is related to human movement.
• TB in Shandong showed significant spatial clustering at scales of 7 km and below.
• TB clusters were related to easy access to provincial/national roads but not rails.
• Transport effects on TB were different between low and high altitude regions.

Human mobility has played a major role in the spread of infectious diseases such as tuberculosis (TB) through transportation; however, its pattern and mechanism have remained unclear. This study used transport networks as a proxy for human mobility to generate the spatial process of TB incidence. It examined the association between TB incidence and four types of transport networks at the provincial level: provincial roads, national roads, highways, and railways. Geographical information systems and geospatial analysis were used to examine the spatial distribution of 2217 smear-positive TB cases reported between 2009 and 2011 in the Shandong province. The study involved factors such as population density and elevation difference in conjunction with the types of transport networks to predict the disease occurrence in space. It identified spatial clusters of TB incidence linked not only with transport networks of the regions but also differentiated by elevation. Our research findings provide evidence of targeting populous regions with well-connected transport networks for effective surveillance and control of TB transmission in Shandong.