Pillaye Jayshree, Clarke Aileen
Division of Public Health Medicine, Brent Primary Care Trust, London, UK.
BMC Public Health. 2003 Oct 6;3:31. doi: 10.1186/1471-2458-3-31.
There has been a resurgence of tuberculosis worldwide, mainly in developing countries but also affecting the United Kingdom (UK), and other Western countries. The control of tuberculosis is dependent on early identification of cases and timely notification to public health departments to ensure appropriate treatment of cases and screening of contacts. Tuberculosis is compulsorily notifiable in the UK, and the doctor making or suspecting the diagnosis is legally responsible for notification. There is evidence of under-reporting of tuberculosis. This has implications for the control of tuberculosis as a disproportionate number of people who become infected are the most vulnerable in society, and are less likely to be identified and notified to the public health system. These include the poor, the homeless, refugees and ethnic minorities.
This study was a critical literature review on completeness of tuberculosis notification within the UK National Health Service (NHS) context. The review also identified data sources associated with reporting completeness and assessed whether studies corrected for undercount using capture-recapture (CR) methodology. Studies were included if they assessed completeness of tuberculosis notification quantitatively. The outcome measure used was notification completeness expressed between 0% and 100% of a defined denominator, or in numbers not notified where the denominator was unknown.
Seven studies that met the inclusion and exclusion criteria were identified through electronic and manual search of published and unpublished literature. One study used CR methodology. Analysis of the seven studies showed that undernotification varied from 7% to 27% in studies that had a denominator; and 38%-49% extra cases were identified in studies which examined specific data sources like pathology reports or prescriptions for anti-tuberculosis drugs. Cases notified were more likely to have positive microbiology than cases not notified which were more likely to have positive histopathology or be surgical in-patients. Collation of prescription data of two or more anti-tuberculosis drugs increases case ascertainment of tuberculosis.
The reporting of tuberculosis is incomplete in the UK, although notification is a statutory requirement. Undernotification leads to an underestimation of the disease burden and hinders implementation of appropriate prevention and control strategies. The notification system needs to be strengthened to include education and training of all sub-specialities involved in diagnosis and treatment of tuberculosis.
全球结核病疫情出现反弹，主要发生在发展中国家，但英国及其他西方国家也受到影响。结核病的控制依赖于病例的早期发现以及及时向公共卫生部门报告，以确保对病例进行适当治疗并对接触者进行筛查。在英国，结核病属于法定报告疾病，做出诊断或怀疑患有结核病的医生负有法定报告责任。有证据表明结核病存在报告不足的情况。这对结核病的控制产生影响，因为在感染人群中，不成比例的是社会中最弱势群体，他们被识别并报告给公共卫生系统的可能性较小。这些群体包括贫困人口、无家可归者、难民和少数族裔。
本研究是对英国国家医疗服务体系（NHS）背景下结核病报告完整性的批判性文献综述。该综述还确定了与报告完整性相关的数据来源，并评估了研究是否使用捕获-再捕获（CR）方法对漏报情况进行校正。如果研究对结核病报告完整性进行了定量评估，则纳入该研究。所使用的结果指标是报告完整性，以定义分母的0%至100%表示，或者在分母未知的情况下，以未报告的病例数表示。
通过对已发表和未发表文献进行电子和人工检索，确定了7项符合纳入和排除标准的研究。其中1项研究使用了CR方法。对这7项研究的分析表明，在有分母的研究中，漏报率在7%至27%之间；在检查病理报告或抗结核药物处方等特定数据来源的研究中，额外发现了38% - 49%的病例。已报告病例的微生物学检测结果呈阳性的可能性比未报告病例更高，未报告病例的组织病理学检测结果呈阳性或为外科住院患者的可能性更大。整理两种或更多抗结核药物的处方数据可提高结核病病例的确诊率。
在英国，尽管报告是一项法定要求，但结核病报告并不完整。报告不足导致对疾病负担的低估，并阻碍了适当预防和控制策略的实施。需要加强报告系统，包括对参与结核病诊断和治疗的所有亚专业进行教育和培训。
