中国与世界不同收入水平地区耐多药结核病疾病负担研究

Disease burden of multidrug-resistant tuberculosis in China and regions with different income levels in the world

目的了解1990—2019年中国与世界不同收入水平地区耐多药结核病的疾病负担情况。方法使用2019年全球疾病负担(Global Burden of Disease,GBD 2019)的研究数据,利用Joinpoint Regression Program 4.8.0.1软件对中国与世界不同收入水平地区耐多药结核病疾病负担状况进行描述。结果1990—2019年除低收入地区年龄标化发病率一直呈上升趋势外,中国与其他不同收入水平地区年龄标化发病率、死亡率、DALY率基本以20世纪末21世纪初为趋势转折点呈先上升后下降趋势。2019年中国耐多药结核病发病率、死亡率、DALY率分别是高收入地区的9、6.67、6.89倍,发病率低于中低收入国家6倍,死亡率、DALY率分别低于低收入国家26倍和32.53倍。结论1990—2019年中国与世界不同收入水平地区耐多药结核病疾病负担,存在明显地区差异(P<0.05)。耐多药结核病仍是世界结核病控制面临的重大挑战,需要更加有效的控制战略和卫生保健系统来应对。

Objective To analyze the disease burden of multidrug-resistant tuberculosis(MDR-TB)in China and regions with different income levels in the world from 1990 to 2019.Methods Using the Global Burden of Disease Study 2019(GBD 2019)results,the changes of the disease burden of MDR-TB in China and regions with different income levels in the world were described and analyzed using the Joinpoint Regression Program 4.8.0.1 software.Results From 1990 to 2019,the age standardized incidence,mortality and DALY rates in China and other areas with different income levels in the world basically showed a trend of first rising and then decreasing at the turning point of the late 20th century and early 21st century,except for low-income areas where the age standardized incidence rate showed an overall upward trend.In 2019,the incidence rate,mortality and DALY rate of MDR-TB in China were 9 times,6.67 times and 6.89 times higher than those in high-income areas,respectively.The incidence rate in China was 6 times lower than that in low and middle-income areas,while the mortality and DALY rate in China were 26 times and 32.53 times lower than those in low-income areas,respectively.The age standardized incidence,mortality rate and DALY rate of MDR-TB in men were higher than those in women.Risk factors for the burden of MDR-TB disease included alcohol consumption,smoking,and high fasting blood glucose.Conclusion From 1990 to 2019,there are significant regional and gender differences in the disease burden of multidrug-resistant tuberculosis in China and regions with different income levels in the world.Multidrug-resistant tuberculosis is still a major challenge for tuberculosis control in the world.It is necessary to develop more effective control strategies and health care systems to deal with multidrug-resistant tuberculosis.