四川省非户籍人口肺结核病患者发现和治疗结果分析

Detection and treatment of pulmonary tuberculosis in non-local residents in Sichuan

目的了解和评价2010-2014年四川省非户籍人口肺结核病跨区域防治管理工作实施情况,探索制约该人群利用公共卫生服务的制度缺陷,为完善其跨区域管理工作提出对策。方法采用定量分析的方法,通过结核病专报信息系统收集四川省21个市州非户籍人口和户籍人口肺结核患者资料进行统计分析。结果 2010-2014年四川省登记户籍人口活动性肺结核患者288 976例,非户籍人口活动性肺结核患者11 005例。非户籍患者来源主要以转诊(34.03%)和追踪(32.86%)为主;在四川省转出的140例非户籍患者中,未反馈率、到位率、代管率均高于转入的1 142例非户籍患者(P=0.001;P=0.024;P=0.028),转出的非户籍人口患者到位率低于户籍人口患者(χ~2=15.558,P=0.001),转出患者在西部地区反馈时间最长,中位数为21 d;非户籍人口新涂阳肺结核患者治疗满1年后丢失率高于户籍人口新涂阳患者(χ~2=20.372,P=0.001),非户籍人口新涂阳肺结核患者完成治疗率在5年间有提高趋势(趋势χ~2=7.768,P=0.005)。结论肺结核患者跨区域管理程序实施是保证非户籍人口肺结核患者持续治疗的有效措施,结核病专报信息系统的管理功能可基本满足工作需要,各级结核病防治机构特别是西部地区应尽力强化督导与协作,加强对非户籍人口患者健康宣传力度,确保该工作顺利开展。

Objective To understand the performance of prevention and treatment of pulmonary tuberculosis （TB） in non- local residents in different areas in Sichuan during 2010 - 2014, identify the factors influencing the access to public health service and provide evidence for the improvement of cross-area TB management. Methods The incidence data of TB in non- local residents and in local residents in 21 prefectures （municipality） in Sichuan were collected through ＂Tuberculosis Reporting Information System＂ for quantitative analysis. Results A total of 288 976 and 11 005 active TB cases were registered in local resident population and in non-local residents respectively in Sichuan from 2010 to 2014. The TB cases in non-local residents were mainly from referral （34. 03% ） and tracing （32. 86% ）. The non-feedback rate, successful referral rate and management rate of 140 TB cases with in-referral were higher than those of 1 142 TB cases with out-referral （P =0. 001 ;P =0. 024;P =0. 028）. The successful referral rate of TB cases in non-local residents was lower than that of TB patients in local residents （x^2 = 15. 558, P = 0. 001 ）. The feedback duration was longest for TB cases with out-referral in western area （21 days）. The lost rate of newly diagnosed smear positive TB cases after 1 year treatment was higher in non- local residents than in local residents （x^2 = 20. 372 ,P = 0. 001 ）, and the complete rate of treatment rate of TB cases in non- local residents increased during the past 5 years（x^trend = 7. 768, P = 0. 005）. Conclusion The cross-area TB management based on TB information management system is effective in continuous treatment for the TB cases in non-local residents. It is necessary to improve the supervision and collaboration and to strengthen the health education in non-local residents for the prevention and control of TB, especially in western area.