2005-2021年福建省学生肺结核报告发病和跨区域流动就诊情况分析

Analysis of reported incidence of pulmonary tuberculosis and cross-regional medical care seeking among students in Fujian Province from 2005 to 2021

目的:分析2005-2021年福建省学生肺结核报告发病和跨区域流动就诊情况,为有效控制学校结核病疫情提供依据。方法:从“全民健康保障信息化工程疾病预防控制信息系统”的子系统“监测报告管理系统”中导出2005-2022年福建省学生的肺结核报告发病数据,按纳入和排除标准删除相关数据后保留发病日期为2005-2021年的学生患者作为研究对象,采用回顾性描述的方法和Joinpoint回归模型分析其变化趋势、年龄分组、跨区域流动就诊等情况。结果:2005-2021年,福建省共报告学生肺结核患者12529例,学生报告发病率从2005年的17.00/10万(1202/7069000)下降至2021年的5.12/10万(466/9103300),总体呈明显下降趋势,平均年度变化百分比为―6.79%(Z=―2.706,P=0.007)。年龄分组中,≤12岁和13~15岁组平均报告发病率分别为0.84/10万(595/71009200)和5.95/10万(1359/22829500),均处于较低水平;但从2012年以来均呈明显上升趋势,分别从2012年的0.41/10万(16/3927100)和4.11/10万(46/1120400)上升至2021年的0.56/10万(29/5201700)和5.90/10万(90/1526100),差异均有统计学意义(APC=6.40,t=2.526,P=0.027;APC=5.57,t=2.208,P=0.047);16~18岁组报告发病率平均为24.93/10万(5165/20715300),≥19岁组报告发病率平均为38.97/10万(5410/13881800),均处于较高水平;≥19岁组报告发病率从2005年的102.60/10万(494/481500)下降至2021年的11.77/10万(139/1181400),总体下降幅度较大(Z=―3.836,P<0.001)。94.43%(11831/12529)的学生肺结核患者在现住址所在地市的医疗机构就诊,5.57%(698/12529)的学生肺结核患者通过跨区域流动就诊,跨区域流动就诊比例从2005年的4.24%(51/1202)上升至2021年的7.51%(35/466),呈上升趋势(Z=―4.901,P<0.001),且具有明显的区域就近流动特征。结论:福建省学生肺结核报告发病率低,总体呈下降趋势,学生患者跨区域流动就诊比例较低。仍需继续加强学校结核病防控工作,尤其要重点关注16~18岁年龄组高中阶段的学生。

Objective:To analyze the reported incidence of pulmonary tuberculosis(PTB)and cross-regional health care seeking of students in Fujian Province from 2005 to 2021,to provide reference for effective tuberculosis control in schools.Methods:The reported incidence data of PTB among students in Fujian Province from 2005 to 2022 were retrieved from the National Health Security Information Project Disease Prevention and Control Information System-Surveillance Management System.After clearing data according to inclusion and exclusion criteria,patients with onset dates from 2005 to 2021 were retained as study subjects.Retrospective description and Joinpoint regression model were used to analyze the incidence change trend among different age groups,and patients’cross-regional medical visits.Results:From 2005 to 2021,a total of 12529 student patients with PTB were reported in Fujian Province.The reported incidence rates of PTB among students showed a significant downward trend,from 17.00/100000(1202/7069000)in 2005 to 5.12/100000(466/9103300)in 2021,the average annual change was-6.79%(Z=-2.706,P=0.007).Among different age groups,the reported incidence rates of students≤12 years old and 13-15 years old were relatively low,averaged as 0.84/100000(595/71009200)and 5.95/100000(1359/22829500)respectively,but showed a significant upward trend since 2012(APC=6.40,t=2.526,P=0.027;APC=5.57,t=2.208,P=0.047),from 0.41/100000(16/3927100)and 4.11/100000(46/1120400)in 2012 to 0.56/100000(29/5201700)and 5.90/100000(90/1526100)in 2021,respectively.The reported incidence rates of students aged 16-18 years old was 24.93/100000(5165/20715300)averagely which was at a higher level and the overall downward trend was not obvious.The reported incidence rates of students aged≥19 years old was 38.97/100000(5410/13881800),which was at a higher level but showed a large overall decline(Z=-3.836,P<0.001),from 102.60/100000(494/481500)in 2005 to 11.77/100000(139/1181400)in 2021.94.43%(11831/12529)of the students with PTB were treated in the medical institutions of the city where their current address was located.5.57%(698/12529)of patients made cross-regional medical visits,and the proportion showed an increasing trend,from 4.24%(51/1202)in 2005 to 7.51%(35/466)in 2021(Z=-4.901,P<0.001),the cross-regional medical care seeking obviously happened mostly in nearby regions.Conclusion:The reported incidence of PTB among students in Fujian Province was low,and the overall trend was obviously decreasing.The proportion of cross-regional medical visits was relatively low.It is necessary to continue to strengthen the prevention and control of tuberculosis in schools,especially focusing on 16-18 years of high school students.