实施定点医院模式与疾控模式的县级地区结核病负担变化趋势

Changing trends of tuberculosis burden in county- level areas implementing designated hospital strategy and CDC TB dispensary strategy

目的分析县级地区实施定点医院模式和疾控模式后结核病负担变化趋势,为完善结核病控制策略提供科学依据。方法南宁市共辖6县,其中隆安县于2005年起实行定点医院模式,其余各县均为疾控模式,本次研究以活动性肺结核病人发病率、死亡率、新发涂阳发现率和治愈率作为评价结核病负担和控制效果的指标,以定点医院模式实施时间作为研究起点,比较2005-2010年不同医防合作模式结核病负担变化趋势。结果南宁市6县2005-2010年登记率平均逐年下降4.3%～16.9%,发病率的下降幅度比登记率更为明显。定点医院模式死亡率平均逐年下降16.2%,新发涂阳治愈率平均逐年提高1.4%,疾控模式各县死亡率下降最快仅为13.7%,而新涂阳治愈率则逐年下降0.5%～0.8%,定点医院模式死亡率下降和治愈率上升的速度均超过疾控模式。疾控模式新涂阳发现率逐年提高0.6%～4.9%,而定点医院模式则下降2.0%。结论 2005-2010年不同医防合作模式地区结核病负担均呈下降趋势,结核病控制效果明显。两种模式相比,南宁市县级定点医院在提高治愈率和降低死亡率方面更具优势。

Objective To analyze the changing trends of tuberculosis （TB） burden in county- level areas implementing desig- nated hospital strategy and CDC TB dispensary strategy, and to provide evidence for improving TB control. Methods Six counties of Nanning City were selected as the study sites, including Longan County implementing designated hospital strategy from 2005 and the other five counties implementing CDC TB dispensary strategy. Morbidity, mortality, new smear - positive de- tection rate （NSPDR） and cure rate were used as the indicators to estimate the changing trends of TB burden and control effects in the six counties implementing different cooperation modes between hospitals and TB prevention and control institutions in TB control strategy from 2005 to 2010. Results An annual decline of 4.3 % - 16.9 % for the notification rate was found in the 6 counties during 2005 - 2010, moreover, a faster decrease of morbidity was observed. The county implementing designated hos- pital strategy had a faster annual decline in the mortality （16.2%） and a faster annual increase in the cure rate of new TB pa- tients （1.4 % ） than the other five counties implementing CDC TB dispensary strategy, which had a slight decrease in the mortal- ity （only 13.7 6%）arid an annual decline in the cure rate of new TB patients （0.5 % - 0.8 % ）. The NSPDRs of the counties im- plementing CI）C TB dispensary strategy gradually increased year by year （0.6 % - 4.9 % ）, while that of the county implement- ing designated hospital strategy gradually decreased year by year （2.0 % ）. Conclusions Thanks to the effective control strate- gies, all the study counties show decrease tendencies in TB burden from 2005 to 2010. Designated hospital strategy is superior to CDC TB dispensary strategy in improving the cure rate and reducing the mortality of tuberculosis.