Dye C, Fengzeng Z, Scheele S, Williams B
Communicable Disease Control, Prevention and Eradication, World Health Organization, Geneva, Switzerland.
Int J Epidemiol. 2000 Jun;29(3):558-64.
Tuberculosis (TB) is still amongst the most important causes of human morbidity and mortality, killing approximately two million people each year. Standard short-course chemotherapy (SSCC) can rapidly control illness and dramatically reduce the chance of death, but the impact of treatment has rarely been evaluated in these terms.
We developed a mathematical model that makes use of routinely-collected data to calculate the number of deaths directly prevented by TB treatment (i.e. excluding those due to reduced transmission). The method was applied to the world's largest TB control programme covering over 500 million people in 12 provinces of China.
Counties which had been enrolled in the programme since 1991 were, by 1997, preventing at least 46% (37-56%) of the TB deaths that would otherwise have occurred. If replicated across the entire TB control programme area, this would amount to 30 000 (range 26 000-59 000) deaths directly prevented each year.
Short-course chemotherapy has substantially reduced TB mortality in half of China. The analytical method described here could be applied to TB control operations in many other countries, and should help to quantify the true burden of tuberculosis alleviated by SSCC.
结核病仍是人类发病和死亡的最重要原因之一，每年导致约两百万人死亡。标准短程化疗（SSCC）可迅速控制病情并大幅降低死亡几率，但治疗的影响很少从这些方面进行评估。
我们建立了一个数学模型，利用常规收集的数据来计算结核病治疗直接预防的死亡人数（即不包括因传播减少导致的死亡）。该方法应用于覆盖中国12个省5亿多人的全球最大结核病控制项目。
自1991年起参与该项目的县到1997年时，至少预防了原本会发生的46%（37%-56%）的结核病死亡。如果在整个结核病控制项目区域推广，每年将直接预防30000例（范围为26000-59000例）死亡。
短程化疗已大幅降低了中国一半地区的结核病死亡率。这里描述的分析方法可应用于许多其他国家的结核病控制行动，并应有助于量化标准短程化疗减轻的结核病实际负担。
