Crimi Paolo, Macrina Gianni, Saettone Francesca, Turello Walter, Ramorino Paola, Gasparini Roberto, Crovari Pietro
Department Of Health Sciences, University of Genoa, Italy.
Eur J Public Health. 2005 Aug;15(4):339-42. doi: 10.1093/eurpub/cki081. Epub 2005 Jun 23.
Tuberculosis (TB) uniformly decreased in all industrialized countries from 1950 to 1985. However, since 1985 an upsurge of the disease has been observed, probably due to the increases in AIDS and immigration. It is for this reason that in the last decade all industrialized countries have intensified their controls on TB and a new reduction has been recently observed.
In this study we collected epidemiological data (mortalities and reported cases) for the region of Liguria over the last 15 years. We then calculated the incidence rate of TB per 100,000 residents according to age, HIV infection and nationality, making a distinction between European Union (EU) citizens and immigrants coming from countries outside the EU.
The rate of mortality, after the last peak at the end of the Second World War, has progressively decreased from 1946 to today, so much so that presently we record fewer than two cases per 100,000 people. We observed a consistent downward trend in the incidence rate up to 1987, but from 1988 onwards this trend stopped and, in subsequent years, we detected an increase in the incidence rate, which peaked in 1996. This led to increased interventions, which has resulted in a considerably decreased overall rate of cases of TB during the last few years. The number of TB cases specifically among foreigners increased considerably during the last 5 years, whereas there was a drastic reduction in the number of total TB cases, as well as an interesting reduction in AIDS cases. During the same period there was a progressive decrease in tuberculin skin positivity in all school classes.
The reduction in TB notifications is probably due to an increase in surveillance and control of social and health conditions. These results show that immigrant workers are considered to be a high-risk group, whereas the risk has progressively decreased in the HIV group.
1950年至1985年期间，所有工业化国家的结核病发病率均持续下降。然而，自1985年以来，该病出现激增，这可能是由于艾滋病病例增加和移民增多所致。正是出于这个原因，在过去十年中，所有工业化国家都加强了对结核病的控制，最近已观察到发病率再次下降。
在本研究中，我们收集了利古里亚地区过去15年的流行病学数据（死亡率和报告病例数）。然后，我们根据年龄、艾滋病毒感染情况和国籍计算了每10万居民的结核病发病率，并区分了欧盟公民和来自欧盟以外国家的移民。
死亡率在第二次世界大战末期达到最后一个峰值后，从1946年到现在逐渐下降，以至于目前我们记录的发病率低于每10万人两例。我们观察到直到1987年发病率一直呈持续下降趋势，但从1988年起这一趋势停止，在随后几年中，我们检测到发病率上升，并在1996年达到峰值。这导致了更多的干预措施，使得过去几年结核病病例总数大幅下降。在过去5年中，外国人中的结核病病例数大幅增加，而结核病病例总数急剧减少，艾滋病病例数也有显著减少。在同一时期，所有学校班级的结核菌素皮肤阳性率都在逐渐下降。
结核病报告病例数的减少可能是由于对社会和健康状况的监测与控制有所加强。这些结果表明，移民工人被视为高危群体，而艾滋病毒感染群体的风险已逐渐降低。
