<sup>*</sup>Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association (RIT/JATA), Tokyo.
<sup>†</sup>Fukujuji Hospital, RIT/JATA, Tokyo, Japan.
Int J Tuberc Lung Dis. 2015 Mar;19(3):312-8. doi: 10.5588/ijtld.14.0104.
To measure the effect of employment and health insurance status on the survival of working age tuberculosis (TB) patients in Japan.
Retrospective cohort analysis of new smear-positive pulmonary TB patients aged 15-59 years registered in the Japanese national TB surveillance system between 2007 and 2010. We performed univariate and multivariate Cox proportional hazard model analysis. The survival curves for employment and health insurance status were calculated using Kaplan-Meier analysis.
Of 9097 patients studied, 267 (2.9%) died of TB within 12 months. After adjustment with a multivariate model, employment and health insurance status were independently associated with increased risk of TB death: unemployment (HR 2.80, 95%CI 2.11-3.72), absence of insurance (HR 1.48, 95%CI 1.02-2.15). The analysis of survival curves indicated that those with public assistance had almost the same survival rate as insured patients in the unemployed group. Permanent workers (employed >30 days) had the highest survival rates, followed by casual workers (employed <30 days) and the unemployed in the insured group.
Patients with permanent jobs had better survival rates than unemployed patients and casual workers. Despite being unemployed, receiving public assistance could improve survival. Health measures are required for the unemployed and casual workers.
衡量就业状况和医疗保险状态对日本工作年龄肺结核（TB）患者生存的影响。
对 2007 年至 2010 年间在日本国家结核病监测系统中登记的新涂阳肺结核患者进行回顾性队列分析，这些患者年龄在 15-59 岁之间。我们进行了单变量和多变量 Cox 比例风险模型分析。使用 Kaplan-Meier 分析计算就业和医疗保险状况的生存曲线。
在所研究的 9097 名患者中，有 267 名（2.9%）在 12 个月内死于结核病。在调整了多变量模型后，就业和医疗保险状况与结核病死亡风险的增加独立相关：失业（HR 2.80，95%CI 2.11-3.72），没有保险（HR 1.48，95%CI 1.02-2.15）。生存曲线分析表明，在失业组中，领取公共援助的人几乎与有保险的人具有相同的生存率。固定工（工作>30 天）的生存率最高，其次是临时工（工作<30 天）和有保险的失业者。
有固定工作的患者比失业患者和临时工的生存率更高。尽管失业，但接受公共援助可以提高生存率。需要为失业者和临时工采取健康措施。
