2015-2019年自贡市结核病患者死因回顾调查分析

Retrospective Investigation on the Death Causes of Tuberculosis Patients in Zigong From 2015 to 2019

目的分析自贡市结核病患者死因状况,为结核病防治提供科学依据。方法通过查阅2015-2019年全市所有户籍人口死亡情况,采用《死亡回顾性调查个案卡》(简称"《个案卡》")对死亡人员的基本情况、死亡情况及结核病诊疗等情况进行调查,将《个案卡》信息录入传染病监测系统,并从系统中导出Excel表格,再应用SPSS 17.0统计软件进行数据处理,主要统计指标有死亡率、死因顺位、构成比等,对率和构成比采用χ2检验,对社会学特征进行多元分析,以P<0.05为差异有统计学意义。结果 2015-2019年全人群共死亡111 513人,死亡率为687.87/10万,5年间死亡率差异有统计学意义(χ2=93.55,P<0.05),最高为2019年(712.20/10万),最低为2016年(654.75/10万);其中结核病死亡383人,死亡率为2.36/10万,占全人群死亡比例为0.34%,5年间结核病死亡率和结核病死亡占总死亡比例差异均无统计学意义(χ2=5.91,P>0.05、χ2=4.98,P>0.05),死因顺位均列第10位;性别、年龄和流动情况是结核病死亡主要的社会学影响因素,男性高于女性(OR=1.28,95%CI:1.03~1.58,P=0.03)、60岁及以上远高于60岁以下(OR=2.16,95%CI:1.14~4.10,P=0.02)、流动人口高于非流动人口(OR=1.86,95%CI:1.23~2.81,P=0.01);结核病死亡患者中主要为复治(227人,59.27%)、病原学阳性(225人,58.75%)、接受过治疗(368人,96.08%)、未在结防机构登记(277人,72.32%)、未规则服药(302人,78.85%);诊断单位最多为县区级医院(171人,44.65%),其次为地市级医院(164人,42.82%);死亡原因主要为肺结核死亡(284人,74.15%),其次为非结核死亡(87人,22.72%);结核病死亡病程平均为7.32年,其中肺结核死亡病程平均为7.28年,肺外结核死亡病程平均为8.02年,非结核死亡病程平均为7.33年;病程1年以内死亡最多(55人,14.36%),其次为5~6年(41人,10.70%)、1~2年(37人,9.66%)、2~3年(36人,9.40%)、3~4年(33人,8.62%),随着病程增加,死亡比例有所下降(χ2=156.21,P<0.05)。结论自贡市结核病死亡率较高,应加强结核病患者归口诊疗和健康管理,提高患者治疗依从性,全面落实全程督导规范化疗,切实提高结核病诊疗技术水平,有效降低结核病死亡率。

Objective To analyze the death causes of tuberculosis(TB) patients in Zigong so as to provide scientific basis for TB prevention and treatment. Methods The deaths of all registered residents in the city from 2015 to 2019 were reviewed by using the "Retrospective Investigation Case Cards of Death"("case card" for short) to investigate the basic information, the death situation and the diagnosis and treatment of TB and so on. Then, the information in the "Case Cards" was recorded into the infectious disease surveillance system. SPSS 19.0 was used for statistical analysis. Main statistical indicators are mortality, cause of death order, and composition ratio. chi-square tests were used,and P<0.05 was considered as statistically significant. Results In2015-2019, a total of 111 513 people died, and the mortality was 687.87/105. There was a significant difference in the mortality over five years (x2=93.55, P<0.05), with the highest in2019(712.20/105) and the lowest in 2016(654.75/105). The mortality of TB was 2.36/105,accounting for 0.34% of the total population. No significant difference of the mortality of TB and the composition ratio of TB mortality in five years (x2=5.91,P>0.05,x2=4.98,P>0.05) were observed. Gender,age and mobility are the major influencing factors of TB mortality. Males(OR=1.28,95%CI=1.03-1.58,P=0.03),60 years old and above(OR=2.16,95%CI=1.14-4.10,P=0.02),and the floating population(OR=1.86,95%CI=1.23-2.81,P=0.01) were associated with higher risk of TB mortality. Main causes of TB deaths were retreatment(227,59.27%),etiological positive(225,58.75%),treated(368,96.08%),not registered in TB prevention institutions(277,72.32%), and irregular medication(302, 78.85%). The most diagnostic units were county and district hospitals(171,44.65%) and prefecture-level hospitals(164,42.82%). The main causes of death were pulmonary TB(284, 74.15%), followed by non-TB(87, 22.72%). The average course of TB deaths was 7.32 years, including 7.28 years of TB deaths, 8.02 years of extrapulmonary TB deaths and 7.33 years of non-TB deaths. Most TB death cases occurred within one year(55 cases,14.36%),followed by 5-6 years(41,10.70%),1-2 years(37,9.66%),2-3 years(36,9.40%),and 3-4 years(33,8.62%). As the course of TB cases increasing,the mortality decreased (x2=156.21,P<0.05). Conclusion The mortality of TB in Zigong is relatively high.Therefore, we should strengthen the centralized diagnosis, treatment and health management of TB patients, improve the treatment compliance of TB patients, fully implement the whole-course supervision and standardized chemotherapy, and earnestly improve the diagnosis and treatment technology level of tuberculosis,effectively reduce the death rate of tuberculosis.