云南省两次县级医疗机构肺结核漏报调查结果对比分析

Comparison of results of two surveys of underreporting of pulmonary tuberculosis in county-level medical institutions in Yunnan

目的评估云南省县级医疗机构在结核病防治服务模式转型前后肺结核漏报变化情况,为研判云南省肺结核疫情水平提供科学数据支撑,为提高医疗机构肺结核疫情报告质量提供参考依据。方法按照全国肺结核漏报统一调查方案,采用概率比例抽样方法选取云南省2015年和2020年县级医疗机构,对医疗机构确诊的肺结核患者进行调查分析,评估肺结核漏报情况。漏报情况组间差异采用χ^(2)检验进行比较,以肺结核患者是否漏报作为因变量,利用logistic回归方程做多因素分析比较。结果2015年肺结核总体漏报率为25.10%,2020年肺结核总体漏报率为1.71%,两者的差异有统计学意义(χ^(2)=1092.742,P<0.001)。多因素分析结果显示,2015年非定点治疗机构[校正比值比(Adjusted Odds Ratio,a OR)=11.118,95%置信区间(Confidence Interval,CI):8.582~14.405]、病房(a OR=1.404,95%CI:1.111~1.774)、无病原学结果(a OR=2.212,95%CI:1.176~4.161)、结核性胸膜炎(a OR=9.398,95%CI:5.595~15.789)和高疫情地区(a OR=1.899,95%CI:1.543~2.337)的患者为医疗机构肺结核漏报的危险因素(均P<0.05);2020年低龄(a OR=4.363,95%CI:1.250~15.321)、无病原学结果(a OR=52.531,95%CI:26.184~105.386)和高疫情地区(a OR=2.040,95%CI:1.146~3.629)的患者为医疗机构肺结核漏报的危险因素(均P<0.05)。结论结核病防治服务模式转型后云南省县级医疗机构肺结核漏报率大幅下降,病原学阳性率提高和肺结核报告职责明确为减少漏报的主要原因。今后仍需关注医疗机构无病原学检查结果、低龄和高疫情地区的肺结核患者报告质量,持续改进医疗机构肺结核漏报问题。

Objective To evaluate the changes of underreporting of pulmonary tuberculosis(TB)before and after the transformation of TB prevention and control service model in Yunnan province,provide scientific data support for accurately assessing the prevalence of pulmonary TB in Yunnan and provide reference for improving the quality of pulmonary TB reporting in medical institutions.Methods According to the national unified investigation protocol of underreporting of pulmonary tuberculosis,the probability proportional sampling method(PPS)was usewd to select county-level medical institutions in Yunnan in 2015 and 2020.The patients diagnosed with pulmonary TB in the medical institutions were investigated and analyzed,and the underreporting of pulmonary T was evaluated.The difference of underreporting between groups was compared byχ^(2) test,and the difference of underreporting of pulmonary TB patients was taken as the dependent variable,and multivariate analysis was performed by logistic regression equation.Results The overall underreporting rate of pulmonary TB was 25.10%in 2015 and 1.71%in 2020,the difference was significant(χ^(2)=1092.742,P<0.001).The results of the multivariate analysis showed that non-designated institutions(AOR=11.118,95%CI:8.582~14.405),hospitalization(AOR=1.404,95%CI:1.111~1.774),no etiological results(AOR=2.212,95%CI:1.176~4.161),tuberculous pleurisy(AOR=9.398,95%CI:5.595~15.789)and area with high TB incidence(AOR=1.899,95%CI:1.543~2.337)were the risk factors of the underreporting in 2015(all P<0.05),Young age(AOR=4.363,95%CI:1.250~15.321),no etiological results(AOR=52.531,95%CI:26.184~105.386)and area with high TB incidence(AOR=2.040,95%CI:1.146~3.629)were the risk factors of the underreporting in 2020(all P<0.05).Conclusion The development of new TB prevention and control service mode is conducive to improve the quality of pulmonary TB reporting in medical institutions at county level in Yunnan,and the improvement of pathogen positive rate and the reporting responsibility of designated medical institutions were the main reasons for reducing the underreporting of pulmonary TB.In the future TB prevention and control,it is still necessary to pa y attention to the reporting of pulmonary TB patients in medical institutions,especially the patients at young age,in areas with high TB incidences and without etiological detection results,and continue to reduce the underreporting of pulmonary TB in medical institutions.