Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA 02115, USA; Harvard School of Public Health, Department of Epidemiology, Boston, MA 02115, USA.
Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA.
Drug Resist Updat. 2014 Oct-Dec;17(4-6):105-23. doi: 10.1016/j.drup.2014.10.001. Epub 2014 Oct 6.
Multidrug resistant tuberculosis (MDR-TB) poses serious challenges for tuberculosis control in many settings, but trends of MDR-TB have been difficult to measure.
We analyzed surveillance and population-representative survey data collected worldwide by the World Health Organization between 1993 and 2012. We examined setting-specific patterns associated with linear trends in the estimated per capita rate of MDR-TB among new notified TB cases to generate hypotheses about factors associated with trends in the transmission of highly drug resistant tuberculosis.
59 countries and 39 sub-national settings had at least three years of data, but less than 10% of the population in the WHO-designated 27-high MDR-TB burden settings were in areas with sufficient data to track trends. Among settings in which the majority of MDR-TB was autochthonous, we found 10 settings with statistically significant linear trends in per capita rates of MDR-TB among new notified TB cases. Five of these settings had declining trends (Estonia, Latvia, Macao, Hong Kong, and Portugal) ranging from decreases of 3% to 14% annually, while five had increasing trends (four individual oblasts of the Russian Federation and Botswana) ranging from 14% to 20% annually. In unadjusted analysis, better surveillance indicators and higher GDP per capita were associated with declining MDR-TB, while a higher existing absolute burden of MDR-TB was associated with an increasing trend.
Only a small fraction of countries in which the burden of MDR-TB is concentrated currently have sufficient surveillance data to estimate trends in drug-resistant TB. Where trend analysis was possible, smaller absolute burdens of MDR-TB and more robust surveillance systems were associated with declining per capita rates of MDR-TB among new notified cases.
耐多药结核病（MDR-TB）在许多环境中对结核病控制构成严重挑战，但难以衡量 MDR-TB 的趋势。
我们分析了世界卫生组织（WHO）在 1993 年至 2012 年间在全球范围内收集的监测和具有代表性的调查数据。我们研究了与新报告结核病病例中估计的人均 MDR-TB 比率线性趋势相关的特定环境模式，以产生与高度耐药结核病传播趋势相关因素的假设。
59 个国家和 39 个次国家地区有至少三年的数据，但在被世界卫生组织指定的 27 个高耐多药结核病负担地区中，不到 10%的人口所在地区有足够的数据来跟踪趋势。在大多数 MDR-TB 是本地获得的环境中，我们发现有 10 个环境中新报告的结核病病例中 MDR-TB 的人均比率呈统计学意义上的线性趋势。其中 5 个环境呈下降趋势（爱沙尼亚、拉脱维亚、澳门、香港和葡萄牙），每年下降 3%至 14%，而 5 个环境呈上升趋势（俄罗斯联邦的四个单独地区和博茨瓦纳），每年上升 14%至 20%。在未调整分析中，更好的监测指标和更高的人均国内生产总值（GDP）与 MDR-TB 的下降相关，而更高的现有 MDR-TB 绝对负担与上升趋势相关。
目前，集中了 MDR-TB 负担的国家中只有一小部分有足够的监测数据来估计耐药结核病的趋势。在可以进行趋势分析的地方，MDR-TB 的绝对负担较小和更健全的监测系统与新报告的结核病病例中人均 MDR-TB 比率的下降相关。
