2008-2020年上海市奉贤区户籍人口肺结核流行特征分析

Analysis of the epidemiological characteristics of pulmonary tuberculosis among registered population in Shanghai Fengxian District from 2008to 2020

目的 分析2008-01-01-2020-12-31上海市奉贤区户籍人口肺结核流行病学特征及发病趋势,为完善上海市户籍人口结核病防控策略提供科学依据。方法 采用《中国疾病预防控制信息系统》子系统《结核病信息管理系统》收集上海市奉贤区2008-2020年户籍人口肺结核资料,包括性别、年龄、职业、登记日期、首诊断单位、诊断结果等,分析该类人群的分布特征,采用Joinpoint回归模型分析时间趋势,计算各年度报告发病率和年度变化百分比(APC)及平均年度变化百分比(AAPC)。结果 2008-2020年报告户籍肺结核患者2 044例,占全人口报告发病例数的47.85%(2 044/4 272);13年间户籍人口报告发病率由2008年的33.89/10万(175例)下降至2020年的23.00/10万(125例),Joinpoint拟合的最优模型中,下降趋势差异无统计学意义,AAPC=-0.6%,t=-1.2,P<0.100;平均报告发病率为29.77/10万(2 044例);男性患者1 552例,女性患者492例,男性平均报告发病率为45.75/10万,高于女性平均报告发病率的14.16/10万,差异有统计学意义,χ^(2)=575.634,P<0.001;男性(APC=AAPC=-0.46%,t=-0.4,P=0.687)和女性(AAPC=-3.7%,t=-0.9,P<0.100)报告发病率均呈下降趋势,但差异无统计学意义;不同年龄组中,60~74岁年龄组构成比占比最多,为31.07%(635/2 044),≥75岁年龄组的平均报告发病率最高,为68.11/10万,各年龄组报告发病差异有统计学意义,χ^(2)=621.665,P<0.001;60~74岁年龄组在2011-2018年出现发病率上升趋势(APC=7.03%,t=1.6,P=0.165);13年间首诊于区、市级医疗机构的占比分别为61.25%和38.75%,差异有统计学意义,χ2趋势=108.336,P<0.001。结论 2008-2020年上海市奉贤区户籍肺结核发病率总体呈波动变化趋势,男性报告发病率高于女性,60~74岁年龄组在2011-2018年发病率呈上升趋势,首诊选择三级医疗机构的患者有上升趋势,肺结核防控工作仍需加强,应重点关注老年人肺结核,进一步完善分级诊疗工作。

Objective To analyze the epidemiological characteristics and incidence trend of pulmonary tuberculosis among registered population in Shanghai Fengxian District from January 1,2008to December 31,2020,and provide scientific basis for improving the prevention and control strategy of tuberculosis among the registered population.Methods The tuberculosis data of registered population in Shanghai Fengxian District from 2008to 2020were collected by using the tu-berculosis information management system,a subsystem of China disease prevention and control information system.In-cluding gender,age,occupation,registration date,first diagnosis hospital,diagnosis results,etc.,Joinpoint regression analysis was performed to analyze chronological trends,annual percentage changes(APC)and average annual percent change(AAPC)were also estimated.Results A total of 2044cases of pulmonary tuberculosis in registered population were reported in Shanghai FengXian from 2008to 2020,accounting for 47.85%(2044/4272)of the reported cases in the whole population,the overall reported incidence rate decreased from 33.89/100000(175cases)in 2008to 23.00/100000(125cases)in 2020,the decreasing trend in the optimal model fitted by Jointpoint had no statistical significance,with AAPC=-0.6%(t=-1.2,P<0.100),the average reported incidence of pulmonary tuberculosis was 29.77/100000(2044cases).Of the reported pulmonary tuberculosis cases 1552were males,with an average reported incidence of 45.75/100000(1552cases),and 492were female with an average reported incidence of 14.16/100000(492cases),the difference were statistically significant(χ^(2)=575.634,P<0.001).The reported incidences in male(APC=AAPC=-0.46%,t=-0.4,P=0.687)and female(AAPC=-3.7%,t=-0.9,P<0.100)both decreased from 2008to 2020.In different age groups,the number of patients aged 60-74years was the most[31.07%(635/2044)].The peak in average reported incidence of the total population was 68.11/100000in the 75and older,there were significant differ-ences in the incidences of pulmonary tuberculosis among different age groups(χ^(2)=621.665,P<0.001).The reported incidence of pulmonary tuberculosis increased in the 60-74years from 2011to 2018(APC=7.03%,t=1.6,P=0.165).In the past 13years,61.25%and 38.75%of the patients were first diagnosed in district and municipal medical institutions respectively(χ^(2) trend=108.336,P<0.001).Conclusions Over the period of 2008to 2020,there is a fluctuating pattern in the overall incidence rate of tuberculosis among registered residents in Fengxian District,Shanghai,and the reported in-cidence rate of males is higher than that of females.The reported incidence of pulmonary tuberculosis show a increase trend in the 60-74years from 2011to 2018.There is an upward trend in the number of patients who choose tertiary hospitals for the first di-agnosis.The efforts to enhance the prevention and control of tuberculosis still require further strengthening.We should focus on the elderly with pulmonary tuberculosis and further improve the graded diagnosis and treatment.