Ospina Jesús E, Orcau Àngels, Millet Joan-Pau, Ros Miriam, Gil Sonia, Caylà Joan A
Servicio de Epidemiología, Agencia de Salud Pública de Barcelona, Barcelona, Spain.
Departamento de Pediatria, Ginecología y Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
PLoS One. 2016 Oct 17;11(10):e0164736. doi: 10.1371/journal.pone.0164736. eCollection 2016.
The increase in immigration in Barcelona between 2000 and 2008 forced a reorganization of the control of tuberculosis (TB). TB clinical units (TBCU) were created and community health workers (CHW) were gradually included.
To understand trends in the incidence of TB among immigrants, their main characteristics and treatment compliance during the period 1991-2013.
We conducted a cross-sectional population-based study of cases detected among immigrants by the Tuberculosis Program in Barcelona, Spain. Sociodemographic, clinical characteristics and risk factors were described. The annual incidence was calculated for various periods and geographical areas of origin. In the linear trend analysis, a p-value of <0.05 was considered statistically significant.
We detected 3,284 cases. Incidence decreased from 144.8/100,000 inhabitants in 1991 to 53.4/100,000 in 2013. Individuals born in Pakistan-India-Bangladesh had the highest average annual incidence (675/100,000). In all, 2,156 cases (65.7%) were male. 2,272 (69.2%) had pulmonary TB, of which 48.2% were smear-positive. 33% of the cases (1,093) lived in the inner city. Contact tracing (CT) coverage in smear-positive individuals rose from 56.8% in 1991-1999 to 81.4% in 2000-2013 (p<0.01); this value was less than 50% in people from Africa and Eastern European countries. The case fatality rate was 3.6% overall and 9.8% among those born in high-income countries (p<0.01). The highest rate of treatment default (12.8%) was observed among cases from the Maghreb. The rate of successful treatment increased from 69.9% in 1991-1999 to 87.5% in 2000-2013 (p<0.01).
The incidence of TB in immigrants is decreasing in Barcelona. Organizational actions, such as incorporating CHWs and TBCUs, have been decisive for the observed improvements.
2000年至2008年间，巴塞罗那移民数量的增加促使对结核病（TB）防控工作进行重新组织。创建了结核病临床单元（TBCU），并逐步纳入社区卫生工作者（CHW）。
了解1991年至2013年期间移民中结核病的发病率趋势、主要特征及治疗依从性。
我们对西班牙巴塞罗那结核病项目在移民中发现的病例进行了一项基于人群的横断面研究。描述了社会人口统计学、临床特征及危险因素。计算了不同时期和不同地理来源地区的年发病率。在线性趋势分析中，p值<0.05被认为具有统计学意义。
我们共检测到3284例病例。发病率从1991年的144.8/10万居民降至2013年的53.4/10万。出生在巴基斯坦 - 印度 - 孟加拉国的个体年均发病率最高（675/10万）。总共2156例（65.7%）为男性。2272例（69.2%）患有肺结核，其中48.2%痰涂片阳性。33%的病例（1093例）居住在市中心。痰涂片阳性个体的接触者追踪（CT）覆盖率从1991 - 1999年的56.8%升至2000 - 2013年的81.4%（p<0.01）；非洲和东欧国家人群的这一数值低于50%。总体病死率为3.6%，高收入国家出生者中的病死率为9.8%（p<0.01）。马格里布地区病例的治疗中断率最高（12.8%）。成功治疗率从1991 - 1999年的69.9%升至2000 - 2013年的87.5%（p<0.01）。
巴塞罗那移民中的结核病发病率正在下降。诸如纳入社区卫生工作者和结核病临床单元等组织行动对所观察到的改善起到了决定性作用。
