2004~2017年我国肺结核发病和死亡的变化趋势

Variation tendency of morbidity and mortality of pulmonary tuberculosis in China between 2004 to 2017

目的分析2004~2017年我国肺结核发病和死亡的变化趋势。方法收集中国公共卫生科学数据中心的肺结核发病和死亡数据,以及国家统计局的人口学资料。采用Excel 2019软件建立肺结核报告发病和死亡数据库。利用JoinPoint 4.9.0.0软件进行JoinPoint回归模型分析,计算2004~2017年我国31个省(市、自治区)、不同年龄段人群肺结核年报告发病率和年报告死亡率的平均年度变化百分比(AAPC),分析2004~2017年我国不同省(市、自治区)、不同年龄段人群肺结核发病和死亡的变化趋势。结果(1)2004~2017年共报告肺结核病例13992987例,年平均报告发病率为74.7632/10万;共报告肺结核死亡病例39316例,年平均报告死亡率为0.2101/10万。(2)2004~2017年我国肺结核报告发病率呈下降趋势(AAPC为-2.50%,P<0.05),报告死亡率维持平稳(AAPC为0.93%,P>0.05)。西藏、青海的报告发病率呈上升趋势,其余29个省(市、自治区)的报告发病率呈下降趋势(21个)或维持稳定(8个);江西、上海、江苏、海南4个省(市)的报告死亡率呈下降趋势,其余省(市、自治区)的报告死亡率维持稳定。(3)肺结核年平均报告发病率在0~10岁人群保持低水平状态,好发于青壮年(10~35岁)和中老年人(55岁及以上)。(4)肺结核年平均报告发病率和年平均报告病死率均与年龄呈正相关(均P<0.05)。22个年龄组的报告发病率呈下降趋势(P<0.05),4个年龄组的报告发病率稳定(P>0.05)。40~45岁人群的报告死亡率呈下降趋势(P<0.05)。结论2004~2017年我国肺结核的报告发病率呈下降趋势,报告死亡率变化呈平稳趋势,其中2006~2017年报告发病率和报告死亡率均呈下降趋势。除西藏、青海外,各省(市、自治区)的发病率维持稳定或呈下降趋势;东南部地区(江西、上海、江苏、海南)的死亡率呈下降趋势,其余省(市、自治区)维持稳定。肺结核在青壮年(10~35岁)和中老年(55岁及以上)人群中高发。建议针对不同地区、不同年龄段人群的肺结核疫情变化情况,加强肺结核防控工作,以减少肺结核发病和死亡病例。

Objective To analyze the variation tendency of morbidity and mortality of pulmonary tuberculosis in China between 2004 to 2017.Methods The data of morbidity and mortality of pulmonary tuberculosis from China Public Health Science Data Center and the demographic data from National Bureau of Statistics were retrieved.The database of reported morbidity and mortality of pulmonary tuberculosis was established by Excel 2019 software.JoinPoint 4.9.0.0 software was employed to conduct JoinPoint regression model analysis and to calculate the average annual percent change(AAPC)of annual reported morbidity and mortality of pulmonary tuberculosis in 31 provinces(cities,autonomous regions),or in various age populations,in China between 2004 to 2017.And the variation tendency of morbidity and mortality of pulmonary tuberculosis in various provinces(cities,autonomous regions),or in various age populations,in China between 2004 to 2017 were analyzed.Results(1)During 2004 and 2017,a total of 13992987 cases of pulmonary tuberculosis were reported,with an average annual reported morbidity of 74.7632 per hundred thousand,and a total of 39316 deaths of pulmonary tuberculosis were reported,with an average annual reported mortality of 0.2101 per hundred thousand.(2)Between 2004 and 2017,the reported morbidity of pulmonary tuberculosis in China interpreted a tendency of decline(with an AAPC of-2.50%,P<0.05),and the reported mortality remained stable(with an AAPC of 0.93%,P>0.05).The reported morbidities of Tibet and Qinghai revealed a tendency of increase,whereas the remaining 29 provinces(cities,autonomous regions)reported a decline in morbidity(21 provinces),or a stable tendency of morbidity(8 provinces);furthermore,four provinces or cities,including Jiangxi,Shanghai,Jiangsu and Hainan,reported a decline tendency of mortality,whereas the reported mortalities of the remaining provinces(cities,autonomous regions)remained stable.(3)In the population aged between 0 to 10 years,the average annual reported morbidity of pulmonary tuberculosis maintained a low-level status,and the disease was more likely to occur in young adults(aged between 10 to 35 year),and middle-aged or elderly people(aged 55 years and above).(4)The average annual reported morbidity and case fatality rate of pulmonary tuberculosis positively correlated with age(all P<0.05).The 22 age groups reported a decline tendency of morbidity(P<0.05),and the reported morbidities of the four age groups remained stable(P>0.05).Population aged between 40 to 45 years reported a decline tendency of mortality(P<0.05).Conclusion Between 2004 to 2017,the reported morbidity of pulmonary tuberculosis in China showed a decline tendency,while the mortality remained stable,wherein the reported morbidity and mortality revealed a decline tendency between 2006 to 2017.Except for Tibet and Qinghai,the morbidity tended to be stable or decreased in the remaining provinces(cities,autonomous regions);in addition,the mortalities of Jiangxi,Shanghai,Jiangsu and Hainan in southeastern China exhibited adecline tendency,whereas the mortalities of the remaining provinces(cities,autonomous regions)tended to be stable.Pulmonary tuberculosis is more likely to occur in the population of young adults at the age of between 10 to 35 years,and middle-age or elderly people aged 55 years and above.It is suggested that pulmonary tuberculosis prevention and control should be strengthened in light with the variation situation of pulmonary tuberculosis epidemic in various areas,or in populations in different ages,thereby reducing the morbidity and death cases of pulmonary tuberculosis.