2011—2020年武汉市老年肺结核流行病学特征

Epidemiological characteristics of pulmonary tuberculosis in the elderly in Wuhan, 2011—2020

目的 研究2011—2020年武汉市老年人(≥60岁)肺结核流行病学特征,为进一步制订精准防控策略提供参考依据。方法 收集国家结核病管理信息系统中2011—2020年武汉市老年肺结核患者病案资料,采用描述性流行病学方法进行患者三间分布、发现方式及治疗转归分析。结果 2011—2020年武汉市共登记老年肺结核患者18 029例,年均登记率141.36/10万。疫情总体呈下降趋势,从2011年116.47/10万降至2020年79.78/10万,年均递降率3.73%。报告发病高峰是每年3—6月,低谷是每年12月至次年2月。男性报告发病率(170.47/10万)高于女性(50.97/10万),差异有统计学意义(χ^(2)=5 474.42,P<0.01)。男女发病数均以60~<70岁组最高,为10 216例(56.66%);男女报告发病率均以70~<80岁年龄组最高(191.80/10万和57.39/10万)。老年肺结核患者数排名前四位为黄陂区2 672例(14.82%)、新洲区2 468例(13.69%)、江夏区1 915例(10.62%)和武昌区1 791例(9.93%),报告发病率排名前四位为新洲区(140.89/10万)、蔡甸区(140.29/10万)、江夏区(118.95/10万)和黄陂区(114.41/10万)。老年肺结核患者以综合医院转诊发现方式为主,其次是基层医疗卫生机构追踪和患者因症就诊。老年肺结核患者治疗转归按诊断地区、性别、年龄段和治疗分类间差异有统计学意义(P<0.05)。结论 武汉市老年人肺结核疫情整体呈缓慢下降趋势,应重点关注70~<80岁男性和经济文化落后、老龄人口较多的远城区,加大健康宣教和主动筛查,加强综合医院疫情报告与转诊工作督导管理,精细化老年人结核病健康管理服务。

Objective To analyze the epidemiological characteristics of tuberculosis among the elderly(aged≥60 years)in Wuhan from 2011 to 2020,so as to provide evidence for promoting precision prevention and control of tuberculosis.Methods The medical records of tuberculosis cases aged 60 and above in Wuhan from 2011 to 2020 registered in the National Tuberculosis Management Information System were extracted.Descriptive epidemiological methods were used to analyze the spatio-temporal and populational distribution,detection mode and treatment outcome.Results From 2011 to 2020,18029 elderly patients of pulmonary tuberculosis were registered in Wuhan,with an average annual registration rate of 141.36/100000.The annual rate showed a declining trend,from 116.47/100000 in 2011 to 79.78/100000 in 2020,with an annual percentage change of−3.73%.The peak of reported incidence was from March to June each year,and the trough from December to February next year.The reported incidence rate in males was statistically significantly higher than that in females(170.47/100000 vs.50.97/100000,χ^(2)=5474.42,P<0.01).The number of cases was the highest in the age group of 60-<70 years in both males and female,accounting for 56.66%of the total number.The reported incidence rate was the highest in the age group of 70-<80 years in both sexes.The four districts with highest proportions of elderly pulmonary tuberculosis patients were Huangpi District(2672 cases,14.82%),Xinzhou District(2468 cases,13.69%),Jiangxia District(1915 cases,10.62%)and Wuchang District(1791 cases,9.93%).As for reported incidence rate,Xinzhou District(140.89/100000),Caidian District(140.29/100000),Jiangxia District(118.95/100000)and Huangpi District(114.41/100000)were the top four districts.The elderly pulmonary tuberculosis patients were mainly diagnosed as a result of referral from general hospitals,less commonly by the follow-up of primary healthcare facilities or healthcare contact after symptom onset.The treatment outcome of elderly patients with pulmonary tuberculosis was statistically significantly different across diagnosis areas,sexes,age groups and treatment classifications(all P<0.05).Conclusions The overall prevalence of elderly tuberculosis in Wuhan is slowly declining.We should focus on men aged 70-<80 years and those in remote urban areas with low cultural and economic development level and a large elderly population.Health education and active screening should be promoted,supervision and management of general hospitals regarding epidemic reporting and referral should be strengthened,and health management services for the elderly tuberculosis patients be more individualized.