2014—2018年全国学生肺结核疫情变化趋势及特征分析

目的 分析全国(不包括我国香港、澳门和台湾地区)学生肺结核(结核性胸膜炎除外)疫情变化及特征,为有效控制学生肺结核疫情提供参考。方法 收集2014—2018年《传染病报告信息管理系统定时报表》、《传染病报告信息管理系统实时报卡》、《结核病管理信息系统》和《中国统计年鉴》中有关学生肺结核疫情和人口的数据(注:信息系统中学生肺结核患者数据有动态实时变化,故报表间数据存在差异),分析学生肺结核报告发病的三间分布和就诊延迟情况。全国在校学生总人数2014年为25800万名,2015年为25581万名,2016年为25927万名,2017年为26275万名,2018年为26867万名。结果 2018年全国共报告学生肺结核患者48289例,报告发病率为17.97/10万(48289/26867万),与2014年(13.91/10万,35881/25800万)相比上升了29.19%[(17.97-13.91)/13.91]。每年3、4月份为学生肺结核报告高峰(2014—2018年分别为4506和4521例、4350和4252例、4802和4110例、4695和3810例、5407和4851例);东部地区(11.64/10万,12391/10641万)疫情较低,中部(15.82/10万,13369/8450万)和西部地区(28.97/10万,22529/7776万)疫情较高;2018年各年龄组学生报告发病例数构成比中,高中阶段(16~18岁组)占比最高,为43.90%(21186/48257),其次是大学本专科阶段(19~22岁组),为31.44%(15172/48257)。2018年学生肺结核患者从出现症状至首次到医疗机构就诊的时间间隔中位数(四分位数)为13(3,33)d,与2017年[13(3,34)d]相比,差异无统计学意义(Z=-0.31,P=0.753);2018年就诊延迟率为47.38%(20643/43572)。结论 2014—2018年学生肺结核疫情呈上升趋势,16~18岁为高发年龄段,西部地区疫情偏高;学生仍然是结核病防控的重点人群之一,应深入开展健康教育,提高主动监测能力。

Epidemic trends and characteristics of pulmonary tuberculosis in students in China from 2014 to 2018

Objective To analyze the epidemic trends and characteristics of pulmonary tuberculosis (PTB, except for tuberculous pleurisy) in the national students in mainland China (not including Hong Kong, Macao and Taiwan), in order to provide a reference for the effective epidemic control of PTB in students.Methods The PTB reporting data in students from the Infectious Diseases Reporting System (IDRS), Tuberculosis Information Management System (TBIMS) and China Statistical Yearbook were collected from 2014 to 2018 to analyze the spatial, temporal and population distribution of reported PTB in students and the patients with delayed treatment. The total number of the national students in China were 258000000 in 2014, 255810000 in 2015, 259270000 in 2016, 262750000 in 2017 and 268670000 in 2018, respectively.Results A total of 48289 student patients with PTB were reported in 2018 with the reported incidence of 17.97/100000 (48289/268670000), increased by 29.19% ((17.97-13.91)/13.91) in comparison with that in 2014 (13.91/100000, 35881/258000000). Annually, March and April were the peak periods for students to report PTB (the reported cases in the two months from 2014 to 2018 were 4506 and 4521, 4350 and 4252, 4802 and 4110, 4695 and 3810, and 5407 and 4851, respectively). The epidemic incidence of the two months was low in the eastern region (11.64/100000, 12391/106410000) and high in the central (15.82/100000, 13369/84500000) and western regions (28.97/100000, 22529/77760000). In the constituent ratio for all age groups in the reported cases in students in 2018, the highest proportion was at senior high school stage (16-18 age group) with an average of 43.90% (21186/48257), followed by college and junior college stage (19-22 age group) with 31.44% (15172/48257). In 2018, the median time interval (quartile) from the onset of symptoms to the first visit to a medical institution for the student patients with PTB was 13 (3, 33) days, which had no difference with that in 2017 (13 (3, 34) days, Z=-0.31, P=0.753). The delayed treatment rate of patients was 47.38% (20643/43572).Conclusion From 2014 to 2018, the epidemic PTB incidence in students had a rising trend, highly occurred in 16-18 ages, and the epidemic incidence was slightly higher in the western region. The students are still one of the important populations for TB prophylaxis. Therefore, health education should be further developed and the capacity for active monitoring should be enhanced.