2010年全国肺结核患病率地区差异分析

Pulmonary tuberculosis prevalence among different regions in China in 2010

目的分析研究中国肺结核患病率东、中、西部及城乡等不同地区分布的差异。方法2010年在全国176个流行病学抽样调查点(简称"流调点"),采用多阶段分层整群等比例抽样方法,对252 940例≥15岁的常住人口进行肺结核症状调查和胸部X线检查。对9825例有肺结核症状、影像学表现异常者和已知肺结核患者进行了痰涂片和痰培养,对380例痰培养阳性者进行菌种鉴定。采用加权法计算患病率,以调整复杂抽样及性别、年龄构成差异造成的影响。采用卡方检验比较不同人群的患病率,并将东、中、西部患病率与我国疾病监测信息报告管理系统2010年的报告发病率数据进行直接比较分析。结果西部乡村活动性、菌阳肺结核患病率分别高达832/10万(497/51 333)、241/10万(145/51 333),均显著高于城镇[286/10万(70/18 563)、70/10万(16/18 563)](χ2值分别为148.16、13.82,P值均<0.01),涂阳肺结核患病率差异无统计学意义(χ2=3.16,P=0.08)。东部乡村活动性、涂阳、菌阳肺结核患病率[364/10万(190/41 763)、62/10万(31/41 763)、91/10万(47/41 763)]也均显著高于城镇[228/10万(150/60 355)、28/10万(18/60 355)、44/10万(28/60 355)](χ2=17.61,P<0.01;χ2=5.19,P=0.03;χ2=6.90,P=0.01)。中部地区乡村、城市活动性、涂阳、菌阳肺结核患病率差异均无统计学意义(χ2=0.35,P=0.56;χ2=1.18,P=0.28;χ2=0.01,P=0.91)。西部地区涂阳肺结核患病率与报告年发病率比值(2.84∶1)高于东部(1.47∶1)和中部(1.50∶1)。发现患者最多的流调点均处于新疆、贵州等边远地区。结论西部、乡村、边远地区肺结核患病率仍较高,应被视为结核病防控的重点地区。

Objective To investigate prevalences of pulmonary tuberculosis among different regions in China.Methods Multi-stage stratified clustered sampling method was adopted,176 clusters were selected.All 252940 residents over 15 years old received investigation and took chest X-ray films.Sputum smear and culture were conducted for 9825 patients with abnormal X-ray film or tuberculosis related symptoms.Strains isolated via culture were taken an identification test to identify M.tuberculosis complex and non-tuberculosis mycobacteria for 380 patients.A weighted adjustment method accounting for complex sampling was used to calculate prevalence and 95% confidence intervals.Second-order Rao-Scott adjusted chi-square test was used to compare prevalences among different groups.Reporting incidences were abstracted from Chinese Infectious Disease Detection Report Information System to compare with prevalences in different regions.Results The weighted prevalence of active,and bacteriological positive pulmonary tuberculosis was 832/100000（497/51333）,241/100000（145/51333） respectively in rural areas in western provinces,significantly higher than those in urban areas of western provinces[286/100000（70/18563）,70/100000（16/18563）],χ2=148.16（P0.01） and 13.82（P0.01）respectively.While for the prevalence of smear positive pulmonary tuberculosis in western provinces,there were no difference found between rural and urban areas（χ2=3.16,P=0.08）.In eastern rural areas,the weighted prevalence of active,smear positive and bacteriological positive pulmonary tuberculosis（364/100000（190/41763）,62/100000（31/41763）,91/100000（47/41763）） were all significantly higher than those in urban areas（228/100000（150/60355）,28/100000（18/60355）,44/100000（28/60355））,χ2=17.61（P0.01）,5.19（P=0.03） and 6.90（P=0.01） separately.In middle provinces,no difference was found between rural and urban areas（χ2=0.35,P=0.56;χ2=1.18,P=0.28;χ2=0.01,P=0.91）respectively for comparison of weighted prevalence of active,smear positive and bacteriological positive pulmonary tuberculosis.Ratio of prevalence and reporting incidence of smear positive pulmonary tuberculosis in western pro-vinces was 2.84∶1,which was higher than that in eastern provinces（1.47∶1） and in middle provinces（1.50∶1）.Survey sites with the highest number of active pulmonary tuberculosis patients detection were all located in remote areas.Conclusion The prevalences of tuberculosis are still high in western,rural or remote areas,which should be regarded as key areas for enhanced tuberculosis control.