Spatiotemporal Heterogeneity of Multidrug-Resistant Pulmonary Tuberculosis Among Local Residents and Internal Migrants in Hangzhou, China, 2014-2024

Background Multidrug-resistant pulmonary tuberculosis (MDR-PTB) poses a severe public health threat in urbanizing China, with internal migrants (IM) facing elevated risks due to socioeconomic disparities and fragmented healthcare. This study examines the spatiotemporal heterogeneity of MDR-PTB among local residents (LR) and IM in Hangzhou (2014–2024) to inform precision interventions. Methods A retrospective analysis of 753 laboratory-confirmed MDR-PTB cases was conducted using data from China’s Tuberculosis Information Management System. Temporal trends were assessed via seasonal-trend decomposition (STL) and Prais-Winsten regression, while spatial clustering was analyzed using Global Moran’s I and Getis-Ord Gi* statistics at the subdistrict level. Results IM constituted 28.3% (213/753) of MDR-PTB cases, exhibiting younger age (mean 35.5 vs. 49.9 years, P <0.001) and higher retreatment rates (51.6% vs. 42.8%, P =0.034) than LR. The proportion of MDR-PTB among all TB cases declined significantly (monthly percent change [MPC]=-0.645%, P <0.001), with sharper reductions in IM post-2019 (case MPC=-0.823%, P =0.002). Spatial analysis revealed hotspots in central urban districts for both populations and migrant-dense suburbs for IM (Moran’s I=0.15-0.17, P <0.001). Conclusions MDR-PTB burden diverges spatiotemporally between IM and LR, driven by migration patterns, healthcare access barriers, and localized transmission. Targeted screening in industrial zones, mobile clinics for migrants, and policy reforms for cross-provincial insurance equity are critical to reducing MDR-PTB in urban China.