不同地区新发涂阳肺结核患者延误水平的变化趋势分析

The tendency of delay between onset of clinical symptoms to initiation of standard TB treatment for new smear positive TB patients in different regions of China

目的了解不同地区新发涂阳肺结核患者延误水平的变化趋势,为制定减少延误发生的干预措施提供科学依据。方法采取典型调查的方法,在东、中、西部各选1个省,共3个省,每省各选择1个县作为研究现场,通过全国结核病网络专报系统获得各调查点2005—2009年患者的个案信息5066例,同时查阅患者病案记录进行核实。使用非参数检验方法,比较各调查点总延误水平的差异和各调查点2005—2009年总延误水平的变化。结果患者中男性占74.7%(3783/5066),女性占25.3%(1283/5066),平均年龄48.1岁(95%CI:47.6～48.6岁),农民占85.5%(4331/5066)。东、中、西部地区患者2005—2009年的平均延误水平分别为24d(0～404d)、42d(0～730d)和62d(0～587d),各调查点延误水平差异有统计学意义(χ2=1095.981,P=0.000);东部地区2005—2009年延误水平的中位数分别为28d(0～398d)、19d(0～387d)、22d(1～404d)、22d(0～219d)和22d(0～96d),差异有统计学意义(χ2=117.840,P=0.000);中部地区2005—2009年延误水平的中位数分别为54d(0～712d)、40d(1～730d)、38d(1～471d)、44d(1～709d)和44d(1～711d),差异无统计学意义(χ2=6.310,P=0.177);西部地区2005—2009年延误水平的中位数分别为91d(5～501d)、67d(0～521d)、42d(4～435d)、51d(3～587d)和59d(4～268d),差异有统计学意义(χ2=166.120,P=0.000)。结论 2005—2009年各调查点延误水平总体上呈下降趋势,但中、西部地区仍有下降的空间。

Objective To describe the tendency of delay between onset of clinical symptoms to initiation of standard TB treatment for new smear positive tuberculosis patients in different regions of China in order to provide evidence base for development of relevant TB control and prevention strategies. Methods Typical survey methods were adopted in this research.Three provinces were selected from the eastern,middle and western regions of China respectively.A total of three counties,one in each selected provinces,were selected as study sites.5066 case-based information of TB patients reported from 2005 to 2009 in the study sites were obtained through national TB-specific report system,meanwhile the information was validated by review of patients’ medical records.Rank sum test was used for to compare the delay between each study site and the tendency of delay from 2005 to 2009 in each site. Results Among the patients,male accounted for 74.7%（3783/5066） and female accounted for 25.3%（1283/5066）.The average age was 48.1 years old（95% CI：47.6-48.6）,85.5%（4331/5066） were farmers.The overall delay from 2005—2009 in eastern,middle and western regions were 24 d（0-404 d）,42 d（0-730 d）and 62 d（0-587 d） respectively,which was significantly different between regions（χ2=1095.981,P=0.000）.The delay from 2005 to 2009 in eastern region were 28 d（0-398 d）,19 d（0-387 d）,22 d（1-404 d）,22 d（0-219 d） and 22 d（0-96 d） respectively,and the differences are significant between years（χ^2=117.840,P=0.000）.For middle region,the corresponding delay by year were 54 d（0-712 d）,40 d（1-730 d）,38 d（1-471 d）,44 d（1-709 d） and 44 d（1-711 d）,the differences are not significant（χ^2=6.310,P=0.177）.For western region,the delay by year were 91 d（5-501 d）,67 d（0-521 d）,42 d（4-435 d）,51 d（3-587 d） and 59 d（4-268 d）,the differences are not significant（χ^2=166.120,P=0.000）. Conclusion There was a downward trend of the delay from 2005 to 2009 in each site,however,for middle and western regions of China,there are still rooms for improvement.