Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Xinshi, Ürümqi, China.
Xinjiang Center for Disease Control and Prevention, Ürümqi, China.
Lancet Glob Health. 2016 Jul;4(7):e485-94. doi: 10.1016/S2214-109X(16)30074-2. Epub 2016 Jun 6.
Progress in tuberculosis control in China has been the slowest in western areas, which have the highest prevalence. We assessed the prevalence of pulmonary tuberculosis in the Xinjiang province, China, 10 years after introduction of a control programme based on directly observed treatment, short course.
In this population-based, cross-sectional survey, we used a multistage stratified random cluster sample design to estimate the prevalence of smear-positive and bacteriologically confirmed (either smear positive or culture positive, or both) pulmonary tuberculosis among adults (aged ≥15 years) in Xinjiang who had been resident in their household for the last 6 months. The screening strategy and diagnosis followed WHO guidelines. We estimated prevalence by combining inverse probability weighting and multiple imputation of missing data. We compared our prevalence survey estimates with the ones from the 2010 China national pulmonary tuberculosis survey and the ones from a provincial pulmonary survey done in Xinjiang in 2000. The new smear-positive pulmonary tuberculosis notification rate in 2011 in Xinjiang was obtained to allow the calculation of patient diagnosis rate (PDR).
Between Sept 1, 2010, and July 31, 2011, 31 081 individuals were eligible, of whom 29 835 (96·0%) participated in the survey. We identified 50 (0·2%) smear-positive and 101 (0·3%) bacteriologically confirmed pulmonary tuberculosis cases. The weighted prevalence of smear-positive pulmonary tuberculosis was 170 (95% CI 103-233) per 100 000 people and of bacteriologically confirmed pulmonary tuberculosis was 430 (249-611) per 100 000 people. Compared with 2000 Xinjiang survey estimates, the prevalence of smear-positive pulmonary tuberculosis has decreased by 26·4% (from 231 [95% CI 148-314] per 100 000 people), whereas the prevalence of bacteriologically confirmed pulmonary tuberculosis has increased by 17·8% (from 365 [237-493] per 100 000 people). In each age group and sex, the pulmonary tuberculosis prevalence was higher in the 2010-11 Xinjiang survey than in the 2010 national survey. The PDR in 2011 was 0·34 (95% CI 0·25-0·44).
Despite progress in other parts of China, the prevalence of pulmonary tuberculosis in Xinjiang remains high. The very low PDR suggests poor access to diagnosis and care. Further studies are needed to understand the barriers to diagnosis and care of this population, and efforts are urgently needed to enhance tuberculosis screening in this area.
Xinjiang Uyghur Autonomous Region Health Bureau.
中国结核病控制进展在西部地区最为缓慢，而这些地区的患病率最高。我们评估了中国新疆维吾尔自治区的肺结核患病率，这是在实施直接观察短程化疗结核病控制规划 10 年后进行的。
在这项基于人群的横断面调查中，我们使用多阶段分层随机聚类抽样设计，估计过去 6 个月在新疆居住的成年人（年龄≥15 岁）中痰涂片阳性和细菌学确诊（痰涂片阳性或培养阳性，或两者均阳性）的肺结核患病率。筛查策略和诊断遵循世界卫生组织的指南。我们通过逆概率加权和缺失数据的多次插补来估计患病率。我们将我们的患病率调查估计值与 2010 年中国全国肺结核调查和 2000 年新疆省级肺结核调查的估计值进行了比较。2011 年新疆新的痰涂片阳性肺结核新发病例报告率用于计算患者诊断率（PDR）。
2010 年 9 月 1 日至 2011 年 7 月 31 日期间，共有 31081 人符合条件，其中 29835 人（96.0%）参加了调查。我们发现了 50 例（0.2%）痰涂片阳性和 101 例（0.3%）细菌学确诊的肺结核病例。加权痰涂片阳性肺结核患病率为 170（95%CI 103-233）/100000 人，细菌学确诊肺结核患病率为 430（249-611）/100000 人。与 2000 年新疆调查估计值相比，痰涂片阳性肺结核的患病率下降了 26.4%（从 231（95%CI 148-314）/100000 人），而细菌学确诊肺结核的患病率上升了 17.8%（从 365（237-493）/100000 人）。在每个年龄组和性别中，2010-11 年新疆调查的肺结核患病率均高于 2010 年全国调查。2011 年的 PDR 为 0.34（95%CI 0.25-0.44）。
尽管中国其他地区取得了进展，但新疆的肺结核患病率仍然很高。非常低的 PDR 表明诊断和治疗的机会有限。需要进一步研究以了解该人群诊断和治疗的障碍，并迫切需要加强该地区的结核病筛查。
新疆维吾尔自治区卫生厅。
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