McLaren Z M, Brouwer E, Ederer D, Fischer K, Branson N
University of Michigan, Ann Arbor, Michigan, USA.
University of Cape Town, Cape Town, South Africa.
Int J Tuberc Lung Dis. 2015 Jan;19(1):104-10. doi: 10.5588/ijtld.14.0212.
In South Africa, tuberculosis (TB) has been the leading cause of death for over a decade. The TB incidence rate is the second highest in the world, and continues to rise.
To examine gender patterns in South Africa's TB epidemic. This is one of the first studies to use National Health Laboratory Service (NHLS) data to evaluate the epidemic at the national level.
Observational study using NHLS retrospective data for every TB test performed in public health facilities between 2009 and 2011.
Despite an increase in the number of TB tests performed, the number of TB cases remained relatively constant. Although prevalence rates differ between health districts, we find a similar female-to-male ratio (0.70) in each district. The age profile for TB resembles that of human immunodeficiency virus (HIV), with peak TB prevalence in women occurring 7 years earlier than in men. The female-to-male ratio of TB cases and 3+ positive (severe) cases decreases rapidly between ages 25 and 35 years.
These age and gender patterns are driven by the HIV epidemic and risks associated with pregnancy and childbearing. Increasing the quality and quantity of active TB case finding at existing points of care would be a sustainable and cost-effective intervention for both treatment and prevention.
在南非，结核病一直是十多年来的主要死因。结核病发病率位居世界第二，且持续上升。
研究南非结核病流行中的性别模式。这是首批利用国家卫生实验室服务（NHLS）数据在国家层面评估该流行病的研究之一。
利用NHLS的回顾性数据进行观察性研究，这些数据来自2009年至2011年在公共卫生机构进行的每一次结核病检测。
尽管结核病检测数量有所增加，但结核病病例数相对保持稳定。虽然各卫生区的患病率有所不同，但我们发现每个区的女性与男性比例相似（0.70）。结核病的年龄分布与人类免疫缺陷病毒（HIV）相似，女性结核病患病率峰值比男性早7年出现。在25岁至35岁之间，结核病病例及3级以上阳性（严重）病例的女性与男性比例迅速下降。
这些年龄和性别模式是由HIV流行以及与妊娠和生育相关的风险所驱动的。提高现有医疗服务点活动性结核病病例发现的质量和数量，将是治疗和预防方面一项可持续且具有成本效益的干预措施。
