Correlation Analysis of Risk Factors for Predicting Tuberculosis Vulnerability in Lampung Province, Indonesia

Abstract

Tuberculosis (TB) remains one of Indonesia's most pressing public-health problems. In Lampung Province, the case notification rate climbed from 330 to 486 per 100,000 population between 2021 and 2024, and the burden differs almost fourfold between the highest- and lowest-ranked districts, a pattern that points to a markedly uneven distribution of disease. This study set out to identify and quantify how strongly epidemiological, environmental, and sociodemographic risk factors are associated with TB vulnerability across the 227 sub-districts of Lampung. We adopted a cross-sectional ecological design drawing on secondary data for 2021–2024, compiled from the national TB information system (SITB), the Provincial Health Office, Statistics Indonesia (BPS), the Meteorology Agency (BMKG), and the 2022 national health survey (Riskesdas). Spearman rank correlation, Kolmogorov–Smirnov and Shapiro–Wilk normality tests, and canonical correlation analysis were applied to 17 variables spanning the three domains. The drug-sensitive TB notification rate showed the strongest positive association with vulnerability (ρ = 0.74; p < 0.001), followed by the proportion of households lacking adequate ventilation (ρ = 0.68), population density ( p-value 0,61), the poverty rate ( p value 0,57), and the TB–HIV co-infection rate (p value 0,52). At the domain level, the epidemiological set produced the strongest canonical association (Rc = 0.79; Rc² = 62.4%). Integrating all three domains accounted for 74.1% of the variance in TB vulnerability, providing an empirical basis for evidence-based prioritisation of interventions in line with the End TB 2030 target.