2016-2020年吉林省老年肺结核流行特征及就诊延迟影响因素分析

Epidemiological characteristics of pulmonary tuberculosis and factors influencing timely medical care seeking in the elderly in Jilin,2016-2020

目的分析“十三五”期间吉林省老年肺结核流行特征,探讨老年肺结核患者就诊延迟的影响因素,为优化老年结核病防治策略提供科学依据。方法收集整理2016—2020年吉林省老年肺结核患者(年龄≥60岁)资料,数据来源于中国疾病预防控制信息系统子系统结核病管理信息系统,通过描述性研究方法分析老年肺结核流行特征,建立老年肺结核患者就诊延迟的多因素logistic回归模型,分析其影响因素。趋势变化分析采用年度变化百分比(APC)。结果老年肺结核5年平均报告发病率为76.49/10万;5年平均病原学阳性率为49.97%,2016—2020年呈逐渐上升趋势(APC=20.68%,t=5.791,P=0.01);男女性别比为2.52∶1,发病年龄中位数为69.13岁,汉族患者20390例,职业为农民的患者12865例,长春市、吉林市、四平市的老年肺结核患者较多,分别为4992例、4351例、3237例,因症就诊/推荐的老年肺结核患者占比最高(50.99%,10890/21359),患者就诊延迟率为75.48%(16121/21359),重症老年肺结核患者为1215例,老年肺结核患者成功治疗率为76.56%(16352/21359)。多因素logistic回归结果显示,与非农民、非流动人口、无病原学结果老年肺结核患者相比,农民[比值比(OR)=1.273,95置信区间(CI):1.193~1.357]、流动人口(OR=1.134,95%CI:1.012~1.272)、病原学阳性(OR=1.260,95%CI:1.180~1.346)是就诊延迟的危险因素;70~岁(OR=0.873,95%CI:0.796~0.957)、初治(OR=0.752,95%CI:0.668~0.846)、重症(OR=0.799,95%CI:0.699~0.914)是就诊延迟的保护因素。结论“十三五”期间吉林省老年肺结核报告发病率先升后降,就诊延迟率较高,需采取综合防治措施提高老年肺结核患者发现水平。

Objective To analyze the epidemiological characteristics of pulmonary tuberculosis(TB)in the elderly in Jilin province during the“13th Five-Year Plan”period,identify the factors influencing timely medical care seeking of pulmonary TB cases in the elderly and provide evidence for the improvement of TB control strategies in the elderly.Methods The incidence data of pulmonary TB in the elderly aged≥60 years in Jilin from 2016 to 2020 were collected from Tuberculosis Management Information System,a subsystem of China Disease Prevention and Control Information System,for a descriptive epidemiological analysis.A multifactorial logistic regression model was established to analyze the factors influencing timely medical care seeking in elderly TB patients.Trend analysis was conducted by using the annual percentage change(APC).Results The average reported incidence rate of pulmonary TB in the elderly was 76.49/100000 in Jilin from 2016 to 2020;the average etiological positive rate of the pulmonary TB cases was 49.97%during this period,showing a gradual upward trend(APC=20.68%,t=5.791,P=0.01).The male to female ratio of the cases was 2.52∶1,the median onset age was 69.13 years,and 20390 cases were reported in Han ethnic group.A total of 12865 cases were farmers,and the cases reported in Changchun(4992 cases),Jilin(4351 cases),and Siping(3237 cases)ranked top three.The proportion of elderly pulmonary TB patients who sought treatment due to symptom or referral was highest(50.99%,10890/21359),the rate of medical care seeking delay was 75.48%(16121/21359),there were 1215 cases of severe pulmonary TB,and the successful treatment rate of the elderly pulmonary TB patients was 76.56%(16352/21359).The multivariate logistic regression analysis results showed that compared with non-farmers,non-floating population,the patients without etiological results and farmers[odds ratio(OR)=1.273,95%confidence interval(CI):1.193–1.357],being in floating population(OR=1.134,95%CI:1.012–1.272),and being etiological positive(OR=1.260,95%CI:1.180–1.346)were the risk factors for medical care seeking delay;being aged 70–80 years(OR=0.873,95%CI:0.796–0.957),being in initial treatment(OR=0.752,95%CI:0.668–0.846),and severe illness(OR=0.799,95%CI:0.699–0.914)were protective factors against medical care seeking delay.Conclusion During the“13th Five-Year Plan”period,the reported incidence rate of pulmonary tuberculosis in the elderly in Jilin showed an increase firstly,then decreased,and the medical care seeking rate of the elderly pulmonary TB patients was high.It is necessary to take comprehensive prevention and control measures to improve the detection of pulmonary TB in the elderly.