Takatorige T, Aoki Y, Tanigake C, Ruful A, Tatara K
Department of Social and Environmental Health, Osaka University Graduate School of Medicine, Japan.
Kekkaku. 2000 Sep;75(9):533-44.
The tuberculosis incidence rate in Osaka City is the highest in Japan. We analyzed the incidence rate in Osaka City in five-year period from 1978 to 1997, namely, 1978-1982 (period I), 1983-1987 (period II), 1988-1992 (period III), and 1993-1997 (period IV). Until the first half of 1980, the tuberculosis incidence rate in Osaka City had been dropping every year, but the rate of decline has been slowed substantially or even stopped since 1983. The incidence rate ratio of Osaka City compared with the national rate was 2.0 to 2.3 from 1970 to 1975, but it has been increasing from 1983 and is now higher than 3. We divided 24 wards of Osaka City into five groups based on selected employment indicators of population 15 years of age and over of 1995 National Census. Group A consists of two wards characterized by extremely high unemployment rate, Group B of four wards by high unemployment rate and high rate of manufacturing workers, Group C of six wards by high rate of non-manufacturing workers (tertiary industry workers), Group D of five wards by high rate of manufacturing workers, and Group E of seven wards by residential areas. The incidence rate of Group A had been declining during periods I and II but started to rise after period III. The rates of Group B and C had been declining from period I to II but the decline slowed down substantially even for every age class in periods III and IV. The incidence rates of Groups D and E have been falling. The incidence rate of the 50-69 year-old age group has been increasing substantially. The proportion of newly registered patients in Group A to all patients of Osaka City increased from 25.2% in period I to 32.7% in period IV. The number of newly registered patients of the 40-69 age class in Group A accounted for 45.1% of that in Osaka City in period IV. The slowdown in the reduction of the tuberculosis incidence rate has occurred not in all, but in only a few wards and it is a typical phenomenon of the middle-aged in those wards. It would be worth investigating whether a substantial decline in the tuberculosis incidence rate in Osaka City cannot be achieved by means of uniform control measures for all wards. Intensified tuberculosis control measures should focus on patients in specific wards and age groups.
大阪市的结核病发病率在日本最高。我们分析了大阪市1978年至1997年这五年期间的发病率，即1978 - 1982年（第一阶段）、1983 - 1987年（第二阶段）、1988 - 1992年（第三阶段）以及1993 - 1997年（第四阶段）。直到1980年上半年，大阪市的结核病发病率每年都在下降，但自1983年以来下降速度大幅放缓甚至停止。1970年至1975年大阪市与全国发病率的比率为2.0至2.3，但自1983年起一直在上升，现在已超过3。我们根据1995年全国人口普查中15岁及以上人口的选定就业指标，将大阪市的24个区分为五组。A组由两个失业率极高的区组成，B组由四个失业率高且制造业工人比例高的区组成，C组由六个非制造业工人（第三产业工人）比例高的区组成，D组由五个制造业工人比例高的区组成，E组由七个按居民区划分的区组成。A组的发病率在第一阶段和第二阶段一直在下降，但在第三阶段后开始上升。B组和C组的发病率从第一阶段到第二阶段一直在下降，但在第三阶段和第四阶段，即使是每个年龄段的下降速度也大幅放缓。D组和E组的发病率一直在下降。50 - 69岁年龄组的发病率大幅上升。A组新登记患者占大阪市所有患者的比例从第一阶段的25.2%上升到第四阶段的32.7%。A组40 - 69岁年龄组新登记患者数量在第四阶段占大阪市的45.1%。结核病发病率下降放缓并非在所有区都出现，而是仅在少数区出现，并且是这些区中年人的典型现象。值得研究大阪市是否无法通过对所有区采取统一控制措施来大幅降低结核病发病率。强化结核病控制措施应侧重于特定区和特定年龄组的患者。
