21 个欧洲国家 1995-2012 年的社会保护与结核病控制：跨国统计模型分析。

Social protection and tuberculosis control in 21 European countries, 1995-2012: a cross-national statistical modelling analysis.

机构信息

Department of Sociology, University of Oxford, Oxford, UK.

School of Medicine, Stanford University, Palo Alto, CA, USA.

出版信息

Lancet Infect Dis. 2014 Nov;14(11):1105-1112. doi: 10.1016/S1473-3099(14)70927-2. Epub 2014 Oct 7.

DOI:10.1016/S1473-3099(14)70927-2

PMID:25303845

Abstract

BACKGROUND

WHO stresses the need to act on the social determinants of tuberculosis. We tested whether alternative social protection programmes have affected tuberculosis case notifications, prevalence, and mortality, and case detection and treatment success rates in 21 European countries from 1995 to 2012.

METHODS

We obtained tuberculosis case notification data from the European Centre for Disease Prevention and Control's 2014 European Surveillance System database. We also obtained data for case detection, treatment success, prevalence, and mortality rates from WHO's 2014 tuberculosis database. We extracted data for 21 countries between Jan 1, 1995, and Dec 31, 2012. Social protection data were from EuroStat, 2014 edition. We used multivariate cross-national statistical models to quantify the association of differing types of social protection programmes with tuberculosis outcomes. All analyses were prespecified.

FINDINGS

After we controlled for economic output, public health spending, and country fixed effects, each US$100 increase in social protection spending was associated with a decrease per 100,000 population in the number of tuberculosis case notifications of -1·53% (95% CI -0·28 to -2·79; p=0·0191), estimated incidence rates of -1·70% (-0·30 to -3·11; p=0·0201), non-HIV-related tuberculosis mortality rate of -2·74% (-0·66 to -4·82; p=0·0125), and all-cause tuberculosis mortality rate of -3·08% (-0·73 to -5·43; p=0·0127). We noted no relation between increased social spending and tuberculosis prevalence (-1·50% [-3·10 to 0·10] per increase of $100; p=0·0639) or smear-positive treatment success rates (-0·079% [-0·18 to 0·34] per increase of $100; p=0·5235) or case detection (-0·59% [-1·31 to 0·14] per increase of $100; p=0·1066). Old age pension expenditure seemed to have the strongest association with reductions in tuberculosis case notification rates for those aged 65 years or older (-3·87% [-0·95 to -6·78]; p=0·0137).

INTERPRETATION

Investment in social protection programmes are likely to provide an effective complement to tuberculosis prevention and treatment programmes, especially for vulnerable groups.

FUNDING

European Centre for Disease Prevention and Control.

摘要

背景

世界卫生组织强调需要针对结核病的社会决定因素采取行动。我们测试了替代社会保护计划是否会影响欧洲 21 个国家的结核病病例报告、患病率和死亡率，以及病例发现和治疗成功率，研究时间为 1995 年至 2012 年。

方法

我们从欧洲疾病预防控制中心 2014 年欧洲监测系统数据库中获得了结核病病例报告数据。我们还从世卫组织 2014 年结核病数据库中获得了病例发现、治疗成功率、患病率和死亡率数据。我们于 1995 年 1 月 1 日至 2012 年 12 月 31 日期间从 21 个国家提取数据。社会保护数据来自 2014 年版的 EuroStat。我们使用多变量跨国统计模型来量化不同类型的社会保护计划与结核病结果之间的关联。所有分析均为预先指定。

结果

在控制经济产出、公共卫生支出和国家固定效应后，社会保护支出每增加 100 美元，每 10 万人的结核病病例报告数量就会减少 1.53%（95%CI-0.28 至-2.79；p=0.0191），估计发病率降低 1.70%（-0.30 至-3.11；p=0.0201），非艾滋病毒相关结核病死亡率降低 2.74%（-0.66 至-4.82；p=0.0125），全因结核病死亡率降低 3.08%（-0.73 至-5.43；p=0.0127）。我们没有注意到增加社会支出与结核病患病率之间存在关联（每增加 100 美元，患病率降低 1.50%[-3.10 至 0.10]；p=0.0639）或涂片阳性治疗成功率之间存在关联（每增加 100 美元，治疗成功率降低 0.079%[-0.18 至 0.34]；p=0.5235）或病例发现之间存在关联（每增加 100 美元，病例发现率降低 0.59%[-1.31 至 0.14]；p=0.1066）。老年养恤金支出似乎与 65 岁及以上人群的结核病病例报告率下降关系最为密切（-3.87%[-0.95 至-6.78]；p=0.0137）。