四川绵阳199182人活动性结核病发病情况及其影响因素分析

The incidence and risk factors of tuberculosis in Mianyang in Sichuan Province

目的对四川绵阳活动性结核病的发病情况进行主动筛查,并分析活动性结核病发病的影响因素。方法纳入2018年3月到2019年4月间参加"四川省绵阳市乙肝与结核病综合防治示范区现场化队列研究"进行结核病筛查人群199182人,采用问卷筛查、DR检查、体格检查和实验室检查等方式收集普通人群结核病发病情况和相关影响因素,采用多因素Logistic回归模型分析结核病发病的影响因素。结果在基于主动筛查的199182名受检人群中共发现活动性结核病患者103例,活动性结核病检出率为51.71/10万。多因素Logistic回归分析显示:60岁及以上[OR=1.74,95%CI(1.11,2.73),P=0.02]、男性[OR=4.39,95%CI(2.74,7.04),P<0.001]、医务人员[OR=11.18,95%CI(2.99,41.84),P<0.001]、有结核病史[OR=16.43,95%CI(8.10,33.33),P<0.001]的人群结核病发病风险增加;随着文化程度提高,普通人群结核病发病风险有降低的趋势。结论基于主动筛查的结核病发现模式有利于活动性结核病患者的检出与结核病防控。老年人、男性、医务人员、结核病史以及文化程度与结核病的新发密切相关,具有以上特征的人群可能是活动性结核病的高危人群,未来应加强对高危人群的监控和预防干预,将有助于结核病防控。

Objective To analyze the incidence and risk factors of tuberculosis in the city of Mianyang based on data from active cases.Methods From March 2018 to April 2019,199182 residents were selected for the study.Data were collected using a questionnaire,digital radiography(DR),physical examination and laboratory tests.The incidence of tuberculosis was estimated,and multivariate logistic regression was used to identify factors associated with the disease.Results Throughout the process,103 residents were diagnosed with active tuberculosis,corresponding to an incidence of51.71 per 100000.Risk of tuberculosis was significantly higher among individuals who were over age 60(OR=1.74,95%CI1.11 to 2.73,P=0.02),males(OR=4.39,95%CI 2.74 to 7.04,P<0.001),medical workers(OR=11.18,95%CI 2.99 to 41.84,P<0.001),and those with a history of tuberculosis(OR=16.43,95%CI 8.10 to 33.33,P<0.001).Conversely,individuals with higher levels of education were associated with lower risk of tuberculosis:compared to those with primary school or less,those with a junior high school education had an OR of 0.53(95%CI 0.30 to 0.88,P=0.02);high school/technical school had an OR of 0.36(95%CI 0.15 to 0.92,P=0.03);junior college or above had an OR of 0.23(95%CI 0.06 to 0.88,P=0.04).Conclusions Analyzing tuberculosis epidemiology based on active cases can help detect the disease as well as control or even prevent epidemics.Individuals who are more senior,males,medical workers,with a history of tuberculosis,and those with lower levels of education may be at higher risk of the disease.These results may improve screening efforts and allow timely intervention.