Martinez A N, Rhee J T, Small P M, Behr M A
Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, USA.
Int J Tuberc Lung Dis. 2000 Jan;4(1):26-31.
Worldwide differences in sex-specific tuberculosis case rates remain fundamentally unexplained.
To explore various factors that may explain sex differences in tuberculosis incidence rates for San Francisco from 1991-1996.
A retrospective epidemiologic analysis of sex-specific tuberculosis incidence rates in San Francisco from 1991-1996. Stratified analyses were performed on age at diagnosis, racial/ethnic group, human immunodeficiency virus (HIV) status, and place of birth. Molecular fingerprinting with IS6110 data was used to study sex differences in the incidence of disease for recently transmitted and reactivated cases of tuberculosis.
In the study period, the male to female incidence rate ratio was 2.1 (95% CI 1.9-2.3). Stratified analyses revealed differences in sex-specific rates after the age of 14 and the highest male:female ratios were seen in the US-born, white, and black populations. High ratios were also observed for cases with clustered fingerprints, similar to those observed for the US-born population. In sub-populations with predominantly reactivated cases of tuberculosis, ratios were also above unity after adolescence, but the effect was less pronounced.
The ongoing transmission of tuberculosis in the US-born population is one of the factors that explains the difference in sex-specific rates of disease in San Francisco. Observed differences in tuberculosis rates between the sexes may be due to a difference in transmission dynamics rather than diagnosis or reporting biases.
全球范围内性别特异性结核病发病率的差异从根本上仍未得到解释。
探讨可能解释1991年至1996年旧金山结核病发病率性别差异的各种因素。
对1991年至1996年旧金山性别特异性结核病发病率进行回顾性流行病学分析。对诊断时的年龄、种族/族裔群体、人类免疫缺陷病毒（HIV）状态和出生地进行分层分析。使用IS6110数据进行分子指纹分析，以研究近期传播和复发的结核病病例中疾病发病率的性别差异。
在研究期间，男女发病率之比为2.1（95%可信区间1.9 - 2.3）。分层分析显示，14岁以后性别特异性发病率存在差异，在美国出生的白人及黑人人群中男女比例最高。聚集性指纹病例的比例也较高，这与在美国出生人群中观察到的情况相似。在以复发型结核病病例为主的亚人群中，青春期后比例也高于1，但影响较小。
在美国出生人群中持续传播的结核病是解释旧金山疾病性别特异性发病率差异的因素之一。观察到的男女结核病发病率差异可能是由于传播动态的差异，而非诊断或报告偏差。
