中国重点人群肺结核患病与发病调查分析

目的 采用连续筛查的方法,调查我国既往结核病患者、活动性肺结核患者密切接触者、糖尿病患者、HIV/AIDS者和65岁及以上老年人(简称“五类重点人群”)的结核病患病和发病情况,以及影响因素,为制定重点人群结核病筛查策略提供基础数据。方法 选择全国东、中、西部10个省(市、自治区)的10个县(区)的27个乡镇(社区)作为研究现场,于2013—2015年连续3年对上述五类重点人群进行面对面问卷调查和胸部X线检查。计算这五类重点人群的肺结核患病率和发病密度,并进行不同人口学特征的单因素和多因素分析。结果 2013—2015年分别筛查了38193、35305和30295名。经过3年的连续筛查,全部重点人群的菌阳肺结核患病率下降了28.9%(246.1-174.9)/246.1×100%],年递降率为15.7%$\big(\sqrt \frac{246.1}{174.9}-1 \big)$×100%];活动性肺结核患病率下降了32.3%(746.2-505.0)/746.2×100%],年递降率为17.7%$\big(\sqrt \frac{746.2}{505.0}-1 \big)$×100%]。以2013年为调查基线,全部重点人群随访1年(2014年)发现的菌阳肺结核和活动性肺结核发病密度分别为132.3/10万人年(36/27202.4)和143.7/10万人年(71/49393.8),随访2年(2015年)则分别为488.9/10万人年(133/27202.4)和475.8/10万人年(235/49393.8)。多因素分析发现:男性、高龄(75~84岁组和≥85岁组)、居住地为农村、少数民族、未婚/离异/丧偶、家庭人均年收入低(2300~9999元)和营养不良(体质量指数<18.5)是结核病患病的危险因素OR(95%CI)值分别为3.4(2.6~4.5)、1.6(1.2~2.2)和2.2(1.3~3.5)、2.0(1.5~2.8)、2.2(1.6~3.0)、1.4(1.1~1.9)、1.8(1.3~2.4)、1.9(1.4~2.6)],超重(体质量指数≥24)是结核病患病的保护因素OR(95%CI)=0.3(0.2~0.5)];男性、少数民族和家庭人均年收入低(2300~9999元)是结核病发病的危险因素aHR(95%CI)值分别为2.5(1.9~3.5)、6.8(4.8~9.6)、1.4(1.0~1.9)],超重(体质量指数≥24)是结核病发病的保护因素aHR(95%CI)=0.5(0.4~0.7)]。结论 五类重点人群是我国肺结核患病和发病的高风险人群,在重点人群中应开展主动连续筛查以快速降低结核病疫情。通过危险因素组合可以获得更高风险的目标人群,从而提高筛查收益。

Study on the prevalence and incidence of pulmonary tuberculosis in high-risk populations in China

Objective To obtain the prevalence,incidence of tuberculosis (TB) and influencing factors among elderly people aged 65 years and older, diabetic patients, people with TB history, close contacts of active TB patients, and HIV/AIDS patients(referred as “five key populations” hereafter) in China through continuous screening, and to provide basic evidence for developing screening strategies in key populations. Methods In 27 townships/communities of 10 counties selected from 10 provinces located in eastern, middle and western regions of China, face-to-face questionnaire surveys and chest X-ray examination were performed on all participants every year for 3 consecutive years. TB prevalence and incidence density of the five key populations were calculated, and univariate and multivariate analysis of different demographic characteristics were also conducted. Results From 2013 to 2015, 38193, 35305 and 30295 participants were screened respectively. After 3 years of continuous screening, the prevalence of bacteriologically confirmed TB in all key populations dropped by 28.9% ((246.1-174.9)/246.1×100%), and the annual decline rate was 15.7% ($\big(\sqrt \frac{246.1}{174.9}-1 \big)$×100%); the prevalence of active TB dropped by 32.3% ((746.2-505.0)/746.2×100%), and the annual decline rate was 17.7% ($\big(\sqrt \frac{746.2}{505.0}-1 \big)$×100%). Taking survey of 2013 as the baseline, the incidence density of bacteriologically confirmed TB and active TB with 1-year follow-up (2014) in all key populations were 132.3 per 100000 person years (36/27202.4) and 143.7 per 100000 person years (71/49393.8), while with 2-years follow-up (2015), they were 488.9 per 100000 person years (133/27202.4) and 475.8 per 100000 person years (235/49393.8). Multivariate analysis found: male, advanced age (group ‘aged 75-84’ and group ‘aged 85 and older’), living in rural areas, ethnic minorities, unmarried/divorced/widowed, low family income per capita (2300-9999 yuan) and malnutrition (body mass index BMI<18.5) were risk factors for TB (OR (95%CI) were 3.4 (2.6-4.5), 1.6 (1.2-2.2) and 2.2 (1.3-3.5), 2.0 (1.5-2.8), 2.2 (1.6-3.0), 1.4 (1.1-1.9), 1.8 (1.3-2.4) and 1.9 (1.4-2.6) respectively), and overweight (body mass index ≥24) was a protective factor for TB (OR (95%CI)=0.3 (0.2-0.5)). Male, ethnic minorities and family with low annual income per capita (2300-9999 yuan) were risk factors for the onset of TB (aHR (95%CI) were 2.5 (1.9-3.5), 6.8 (4.8-9.6), 1.4 (1.0-1.9)), and overweight (BMI≥24) was a protective factor for the onset of TB (aHR (95%CI) was 0.5(0.4-0.7)). Conclusion The five key populations are high-risk populations of TB in China. Continuous active screening should be carried out in those key populations to quickly reduce the tuberculosis epidemic. Through identify people with different combinations of risk factors, we can set high-risk populations to target at them, thereby to increase the screening benefits.