Coffman Jenna, Chanda-Kapata Pascalina, Marais Ben J, Kapata Nathan, Zumla Alimuddin, Negin Joel
School of Public Health, University of Sydney, Sydney, Australia.
Department of Disease Surveillance, Control and Research, Ministry of Health, Lusaka, Zambia.
BMC Public Health. 2017 Oct 12;17(1):804. doi: 10.1186/s12889-017-4836-0.
The 2010 Global Burden of Disease estimates show that 57% of all TB deaths globally occurred among adults older than 50 years of age. Few studies document the TB burden among older adults in Southern Africa. We focused on adults older than 55 years to assess the relative TB burden and associated demographic factors.
A cross sectional nationally representative TB prevalence survey conducted of Zambian residents aged 15 years and above from 66 clusters across all the 10 provinces of Zambia. Evaluation included testing for TB as well as an in-depth questionnaire. We compared survey data for those aged 55 and older to those aged 15-54 years. Survey results were also compared with 2013 routinely collected programmatic notification data to generate future hypotheses regarding active and passive case finding.
Among older adults with TB, 30/ 54 (55.6%) were male, 3/27 (11.1%) were HIV infected and 35/54 (64.8%) lived in rural areas. TB prevalence was higher in those aged ≥55 (0.7%) than in the 15-54 age group (0.5%). Males had higher rates of TB across both age groups with 0.7% (15-54) and 1.0% (≥55) compared with females 0.4% (15-54) and 0.6% (≥55). In rural areas, the prevalence of TB was significantly higher among older than younger adults (0.7% vs 0.3%), while the HIV infection rate was among TB patients was lower (11.1% vs 30.8%). The prevalence survey detected TB in 54/7484 (0.7%) of older adults compared to 3619/723,000 (0.5%) reported in 2013 programmatic data.
High TB rates among older adults in TB endemic areas justify consideration of active TB case finding and prevention strategies.
2010年全球疾病负担估计显示，全球所有结核病死亡病例中有57%发生在50岁以上的成年人中。很少有研究记录南部非洲老年人的结核病负担。我们重点关注55岁以上的成年人，以评估相对结核病负担及相关人口统计学因素。
对赞比亚10个省66个群组中15岁及以上的赞比亚居民进行了一项具有全国代表性的横断面结核病患病率调查。评估包括结核病检测以及一份深入的调查问卷。我们将55岁及以上人群的调查数据与15 - 54岁人群的数据进行了比较。调查结果还与2013年常规收集的项目通报数据进行了比较，以生成关于主动和被动病例发现的未来假设。
在患有结核病的老年人中，30/54（55.6%）为男性，3/27（11.1%）感染了艾滋病毒，35/54（64.8%）生活在农村地区。≥55岁人群的结核病患病率（0.7%）高于15 - 54岁年龄组（0.5%）。两个年龄组中男性的结核病发病率均较高，15 - 54岁组为0.7%，≥55岁组为1.0%，而女性在15 - 54岁组为0.4%，≥55岁组为0.6%。在农村地区，老年人的结核病患病率显著高于年轻人（0.7%对0.3%），而结核病患者中的艾滋病毒感染率较低（11.1%对30.8%）。患病率调查在7484名老年人中检测出54例结核病（0.7%），而2013年项目数据报告的723,000人中为3619例（0.5%）。
结核病流行地区老年人的高结核病发病率证明有必要考虑采取主动结核病病例发现和预防策略。
