Global Geographical Distribution of Mycobacterium Tuberculosis Complex and the Association Between GHSI and Drug-Resistant Tuberculosis

Background: Mycobacterium tuberculosis complex (MTBC) is the causative agent of tuberculosis (TB), which comprises several phylogenetically distinct lineages associated with different geographical regions. The Global Health Security Index (GHSI) has been developed to measure a country's capacity to cope with a public health emergency, but it lacks sufficient evidence corresponding association between GHSI and drug-resistant TB (DR-TB). The objectives of this study were to map the global distribution of MTBC lineage and to explore the correlation between GHSI and the prevalence of DR-TB globally. Methods: The GHSI, whole-genome sequencing (WGS), and verified data of TB were extracted from the online database, including the GHSI website, TBProfiler website, and Global Tuberculosis Report, respectively. We mapped the global geographic distribution of MTBC lineages. The hierarchical structure was visualized in different continents and sublineages, while the DR-TB was visualized by an error bar plot. We also performed two-dimensional twisted surface and interaction plots to explore the interaction between GHSI and gross domestic product (GDP) per capita on the prevalence of DR-TB. Findings: Lineage 4 was widely distributed globally and followed by East Asian lineage 2. Lineage 2 had the highest risk of developing DR-TB. We observed an interaction between ln(GHSI) and ln(GDP per capita) on the prevalence of multidrug-resistant TB (MDR-TB). We revealed a negative association between ln(GHSI) and DR-TB in countries whose ln(GDP per capita) were greater than 2.35. Interpretation: Lineage 4 is the most widely distributed, and lineage 2 is the most prevalent lineage with DR-TB. There was a negative association between GHSI and DR-TB but not in the countries with low income. More funding is needed to “End TB targets”, especially in low-income countries.Funding Statement: This study was funded by the National Key R&D Program of China (2017YFC0907000), Key Project of Philosophy and Social Science Research in Colleges and Universities in Jiangsu Province (2020SJZDA096), National Natural Science Foundation of China (81973103), and Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD).Declaration of Interests: The authors report no conflicts of interest in this work.Ethics Approval Statement: This study was approved by the ethics committee of Nanjing Medical University.