Arsang-Jang Shahram, Mansourian Marjan, Amani Firouz, Jafari-Koshki Tohid
Department of Biostatistics and Epidemiology, School of Health, Qom University of Medical Sciences, Qom, Iran.
Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
J Res Health Sci. 2017 May 20;17(2):e00380.
Trend analysis is an important tool to monitor epidemiological changes of disease over time to guide resource allocation. This study aimed to study incidence trends and change-points of smear positive, smear negative, extra-pulmonary and relapse of tuberculosis (TB) in Iran from 2001 to 2015.
Repeated cross-sectional study METHODS: Nonlinear segmented regression was used to describe TB incidence trends; annual percent change (APC), average annual percent changes (AAPC) and change points for each disease separately.
Of 154930 TB cases, 49.8% were smear positive, 19.7% smear negative, 27.32% extra-pulmonary and 3.18% relapse. For all TB types, the peak of incidence was in 2001. Two change point were estimated for all TB types (P<0.05). The APC of all TB types were -6.51 (95% CI: -7.4, -5.4) for first and 2.4 (95% CI: 0. 7, 4.1) for second segment. Although the trends were significantly decreasing from 2001 to 2015 for smear positive (AAPC=2.06%), smear negative (AAPC=3.57%), extra pulmonary (AAPC=3.2%) and relapse (AAPC=3.3%), the AAPCs of trends were not significant from 2006 to 2015. Except for Extra pulmonary TB (APC=4-.9%, 95%CI:-10, 1.2), the APCs of the last segments were significant.
Even though the TB incidence rates were decreasing, the amount of reductions seem inadequate, to reach the goals of TB control in Iran. Especially, the increase in the extra-pulmonary TB rates is a point of concern that highlights more attention is required for these cases. It is essential to improve economic supports toward TB control, illegal immigrants, data registry systems and physician's sensitivity in TB detection.
趋势分析是监测疾病流行病学随时间变化以指导资源分配的重要工具。本研究旨在探讨2001年至2015年伊朗涂片阳性、涂片阴性、肺外及复发性结核病（TB）的发病率趋势和变化点。
重复横断面研究
采用非线性分段回归描述结核病发病率趋势；分别计算每种疾病的年度百分比变化（APC）、平均年度百分比变化（AAPC）和变化点。
在154930例结核病病例中，49.8%为涂片阳性，19.7%为涂片阴性，27.32%为肺外结核，3.18%为复发性结核。所有类型的结核病发病率峰值均出现在2001年。估计所有类型结核病有两个变化点（P<0.05）。第一段所有类型结核病的APC为-6.51（95%CI：-7.4，-5.4），第二段为2.4（95%CI：0.7，4.1）。尽管2001年至2015年涂片阳性（AAPC=2.06%）、涂片阴性（AAPC=3.57%）、肺外结核（AAPC=3.2%）和复发性结核（AAPC=3.3%）的发病率趋势显著下降，但2006年至2015年趋势的AAPC不显著。除肺外结核（APC=4.9%，95%CI：-10，1.2）外，最后一段的APC显著。
尽管结核病发病率在下降，但下降幅度似乎不足，难以实现伊朗结核病控制目标。特别是，肺外结核发病率的上升令人担忧，这突出表明需要对这些病例给予更多关注。必须加强对结核病控制、非法移民、数据登记系统以及医生结核病检测敏感性的经济支持。
