2009-2016年湖南省登记肺结核患者来源分析

Sources of tuberculosis patients registered in Hunan Province,2009-2016

目的了解2009-2016年湖南省登记肺结核患者来源的分布特征情况。方法从"中国疾病预防控制信息系统结核病管理信息系统"分年度查询下载2009-2016年湖南省肺结核患者登记报告数据。用Excel 2007和SPSS 13.0软件描述和分析不同地区和年份患者来源分布特征及变化趋势。结果 2009-2016年湖南省共登记肺结核患者447 341例,2009-2015年患者发现数趋于平稳,2016年患者发现数稍有下降。2009-2016年登记肺结核患者绝大部分来源于因症就诊、转诊和追踪,共有431 217例,占所有患者的96.4%,这三类患者分别占总病例的41.08%、32.33%和23.00%。2009-2016年各市州患者来源分布差异有统计学意义(χ~2=64 532.912,P=0.000)。岳阳市(55.67%)、邵阳市(52.58%)和张家界市(49.44%)患者来源中均是因症就诊比例最大,占到了登记患者的一半或以上。郴州市(47.53%)、湘潭市(45.46%)、湘西自治州(45.26%)转诊是患者主要来源。长沙患者主要来源于追踪(46.39%)。2009-2016年全省不同年度登记肺结核患者来源差异有统计学意义(χ~2=10 142.484,P=0.000);各年度因症就诊患者比例呈缓慢下降趋势(χ_(趋势)~2=2 434.161,P=0.000);但追踪比例呈逐年上升趋势(χ_(趋势)~2=8 844.858,P=0.000)。结论 2009-2016年湖南省登记肺结核患者主要来源于因症就诊,其次是转诊和追踪,但近几年来因症就诊比例呈下降趋势,追踪比例在逐渐上升,转诊比例也稍有增加;不同市州登记患者来源存在差异。提示在强化健康教育重要性的同时,要加强医防合作,认真落实患者追踪工作,要针对不同市州特点不断优化患者发现方式。

Objective To investigate the characteristics of source distribution of tuberculosis patients registered in Hunan Prov- ince from 2009 to 2016. Methods We downloaded the reported data of tuberculosis patients registered in Hunan Province dur- ing 2009-2016 from Tuberculosis Management Information System, China Information System for Disease Prevention and Control. The distribution characteristics and variation trends of sources of patients registered in different regions and years were described and analyzed by Excel 2007 and SPSS13.0 software. Results A total of 447,341 patients with tuberculosis were reported in Hu- nan Province from 2009 to 2016. The number of the registered patients during the period of 2009-2015 was stable, but there was a slight decrease in the number of the registered patients in 2016. The vast majority （n = 431,217, 96.4%） of tuberculosis patients were found or confirmed by disease treatment （ 41.08% ） , referral （ 32.33% } and follow-ups （ 23.00% ）. There were statistically significant differences in the distribution of the patients＇ sources among cities and prefectures in Hunan Province from 2009 to 2016 （χ2= 64,532.912, P= 0.000}. Disease treatment was the major source among the patients in Yueyang City （55.67%）, Shaoyang City （ 52.58% ） and Zhangjiajie City （ 49.44% ）, which accounted for more than half of the patients registered. Referral was the major source among the patients in Chenzhou City （ 47.53% ）, Xiangtan City（ 45.46% ） and Xiangxi Tujia and Miao Autonomous Prefecture （ 45.26% ）. The main source of the patients in Changsha City was follow-ups （ 46.39% }. The differences in the source distribution of patients registered in different years in Hunan Province during 2009 - 2016 were statistically significant （χ2= 10,142.484,P=0.000}. The proportion of patients with disease treatment in each year showed a slow downward trend （χ2=2,434.161 ,P= 0.000）, while the proportion of patients with follow-ups showed a gradually increased tendency （χ2= 8,844. 858, P=0.000）. Conclusions The main source of tuberculosis patients registered in Hunan Province from 2009 to 2016 is disease treatment, followed by referral and follow-ups. The proportion of disease treatment shows a declined tendency in recent years,while the proportion of follow-ups increases gradually and the proportion of referral increases slightly. The patients registered in dif- ferent cities and prefectures vary in the distribution of sources. The results suggest that strengthening the cooperation between the medical and epidemic prevention departments, earnestly implementing the patients＇ follow-ups, and continuously optimizing the methods of patient discovery according to the characteristics of different cities and prefectures are necessary while intensifying the importance of health education.