Martineau A R, Lowey H, Tocque K, Davies P D O
Newham Chest Clinic, Shrewsbury Centre, London, United Kingdom.
Int J Tuberc Lung Dis. 2004 Jun;8(6):737-42.
Despite declining tuberculosis mortality per head of population, there was little change in tuberculosis case fatality in England and Wales from 1974 to 1987.
To determine the trend in tuberculosis case fatality for England and Wales from 1988 to 2001.
Annual deaths to notifications ratios (DNRs) for tuberculosis were calculated using published notification and mortality data, and analysed by age group and three disease sites (central nervous system [CNS], respiratory and other). DNRs for seven disease sites (miliary, bone and joint, CNS, respiratory, genitourinary, gastrointestinal and other) were calculated for 1998 and 1999 combined, using additional data from the enhanced tuberculosis surveillance programme.
DNR for all ages and disease sites combined fell from 9.26% in 1988 to 5.59% in 2001 (r = -0.90; 95%CI -0.97 - -0.70). DNRs for 1998-1999 combined were 41% for miliary disease, 17% for bone and joint disease, 8% for CNS disease, 7% for respiratory disease, 2% for genitourinary and gastrointestinal disease and 0.6% for other disease.
Some of the decrease in DNRs may be due to improving notification rates. True declines in overall case fatality reflect increases in the proportion of tuberculosis patients in younger age groups and with low mortality extra-pulmonary disease.
尽管人均结核病死亡率有所下降，但1974年至1987年间，英格兰和威尔士的结核病病死率几乎没有变化。
确定1988年至2001年英格兰和威尔士结核病病死率的趋势。
利用已公布的通报和死亡率数据计算结核病的年度死亡与通报比（DNR），并按年龄组和三个疾病部位（中枢神经系统[CNS]、呼吸道及其他）进行分析。利用强化结核病监测计划的额外数据，计算了1998年和1999年合并的七个疾病部位（粟粒性、骨与关节、中枢神经系统、呼吸道、泌尿生殖系统、胃肠道及其他）的DNR。
所有年龄组和疾病部位合并的DNR从1988年的9.26%降至2001年的5.59%（r = -0.90；95%CI -0.97 - -0.70）。1998 - 1999年合并的DNR，粟粒性疾病为41%，骨与关节疾病为17%，中枢神经系统疾病为8%，呼吸道疾病为7%，泌尿生殖系统和胃肠道疾病为2%，其他疾病为0.6%。
DNR的部分下降可能归因于通报率的提高。总体病死率的真正下降反映了年轻年龄组结核病患者比例的增加以及肺外疾病低死亡率的情况。
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