湖南省不同职业、年龄肺结核患者流行特征及重点人群防控策略分析

Analysis on Preventive Measures of TB in Different Profession and Age in Hunan Province

目的:综合分析湖南省肺结核患者职业、年龄流行特征及现行重点人群防治政策和措施,为结核病重点人群防治提供思路及建议。方法:回顾性分析2012-2018年中国结核病信息管理系统湖南省肺结核患者(含结核性胸膜炎)登记信息,以及2014-2018年湖南省卫生健康委档案资料。结果:2012-2018年肺结核患者(含结核性胸膜炎)登记发病率总体呈现下降趋势(趋势χ^2=1694.954,P<0.001),2018年登记发病率略有上升,为75.81/10万。不同职业患者分布差异有统计学意义(χ^2=5229.239,P<0.001);2013-2018年排名前5位的职业包括农牧渔民、家务及待业、离退人员、工人和学生;各年份农牧渔民患者登记占比均超过74%;2018年学生患者登记数(2839,5.50%)较2017年(1547,3.10%)增加近1倍。不同年龄组患者登记分布差异有统计学意义(χ^2=2512.89,P<0.001);随年龄增大,患者登记数及构成比增大,其中,65~岁组最大,且随时间升高。2014-2018年湖南省卫生健康委共出台结核病防治文件66个,平均每年出台13.40个。其中,重点人群防治文件9个(涉及学校防控8个,老年人群、糖尿病患者防控1个)。2018年政策文件明显增多,新出台部门职责、日常防控、疫情处置等学校防控政策,及入学新生、糖尿病患者、65岁及以上人群主动筛查政策。结论:加强重点人群防控,尤其是实施主动筛查等措施,是应对当前结核病防控形势,满足实际工作需要的重要策略和手段。未来湖南省应以效果为导向,不断完善现有学生、老年人群、糖尿病患者防控措施,并适时开展农牧渔民、家务及待业、离退人员、工人等职业的重点干预。

Objective:To investigate the profession and age distribution of TB as well as preventive measures in Hunan province,to provide references for improving TB control strategies.Methods:Registration rate and epidemiological characteristics of TB in Hunan province were analyzed through data registered in China Tuberculosis Information Management System between 2012 and 2018.Policies information of TB control were collected from government documents which Hunan Provincial Health Commission outgoing between 2014 and 2018.Results:From 2012 to 2018,in Hunan province,the registration rate of TB tended to decline(χ^2=1 694.954,P<0.001)and rose slightly in 2018 in detail.The top five profession TB registered were farmer(herdsmen and fishermen),housekeeper(unemployed),retiree,worker and student during 2013 and 2018,which were significantly different(χ^2=5 229.239,P<0.001).Farmers(herdsmen and fishermen)made up the largest percentage of TB population,over 74%in each year.The number of student-patient registrations in 2018(2 839,5.50%)nearly doubled compared with 2017(1 547,3.10%).With the increase of age,the registration number and composition ratio of the patients increased(χ^2=2 512.89,P<0.001),among which,the 65-year-old group was the largest,and increased with the time.A total of 66 TB control documents were issued by Hunan Provincial Health Commission from 2014 to 2018,with an average of 13.40 per year.Among them,there were 8 documents about the preventive measures of students and 1 for the elderly population and diabetes).Policy documents increased significantly in 2018,including departmental responsibilities,routine prevention and control,epidemic management and other school prevention and control policies,as well as active screening policies for freshmen,diabetic patients,and people aged 65 or above.Conclusions:Active screening can improve the detection level of tuberculosis patients and promote the prevention and control of tuberculosis.Hunan Province should continue to improve the prevention and control measures for students,elderly people and diabetic patients,and carry out timely intervention in farmers(herdsmen and fishermen),workers,housekeepers(unemployed),retirees,workers and other professions.