Arnedo-Pena Alberto, Romeu-Garcia Maria Angeles, Meseguer-Ferrer Noemi, Vivas-Fornas Iraya, Vizcaino-Batllés Ana, Safont-Adsuara Lourdes, Bellido-Blasco Juan Bautista, Moreno-Muñoz Rosario
Epidemiology Division, Public Health Center, Castellon, Spain.
Department Medicine Preventive and Public Health, Faculty of Health Sciences, Public University of Navarra, Pamplona, Spain.
Microbiol Insights. 2019 Apr 4;12:1178636119840362. doi: 10.1177/1178636119840362. eCollection 2019.
Tuberculosis (TB) incidence remains low in health departments of Castellon and La Plana-Vila-real, but TB elimination is challenging. The objective of this study was to estimate associated factors of pulmonary tuberculosis (PTB) compared with extrapulmonary tuberculosis (ETB) and investigate epidemiological characteristics of these pathologies to orient control and prevention actions.
A prospective case-case study was implemented by comparing PTB and ETB incidences during 2013-2016 from notification reports, epidemiological surveillance, and microbiological results of hospitals' laboratories Hospital General Castellon and La Plana-Vila-Real in the province of Castellon of Valencia region in Spain. In this design, cases were patients with PTB and controls were patients with ETB. Directed acyclic graph approach was used for selection of potential risk and confounding factors. Adjusted odds ratios (AORs) were estimated by logistic regression models.
The study included 136 patients with PTB and 57 patients with ETB, with microbiological confirmation of 93.4% and 52.6%, and the annual median of incidence rates were 7.5 and 3.1 per 100 000 inhabitants, respectively. In general, patients with PTB were younger with higher male proportion than patients with ETB. Risk factors of PTB were smoking tobacco (AOR = 3.98; 95% confidence interval [CI] = 1.66-9.56), social problems (social marginalization, homeless, residence in shelters for the poor, or stay in prison) (AOR = 3.39; 95% CI = 1.05-10.94), and contact with patients with TB (AOR = 2.51; 95% CI = 1.06-5.95). No-smoking tobacco and no-drug abuse interaction decrease PTB risk (AOR = 0.27; 95% CI = 0.12-0.64). From these results, specific measures of health promotion and prevention can be addressed.
The estimated associated factors of PTB may be prevented, and it was demonstrated that the case-case design is useful in the study of TB.
在卡斯特利翁和拉普拉纳 - 比利亚雷亚尔的卫生部门，结核病（TB）发病率仍然较低，但结核病消除工作具有挑战性。本研究的目的是评估肺结核（PTB）与肺外结核（ETB）相比的相关因素，并调查这些病症的流行病学特征，以指导控制和预防措施。
通过比较2013 - 2016年西班牙巴伦西亚地区卡斯特利翁省卡斯特利翁综合医院和拉普拉纳 - 比利亚雷亚尔医院的通报报告、流行病学监测及医院实验室的微生物学结果中的PTB和ETB发病率，实施了一项前瞻性病例对照研究。在该设计中，病例为PTB患者，对照为ETB患者。采用有向无环图方法选择潜在风险和混杂因素。通过逻辑回归模型估计调整后的优势比（AOR）。
该研究纳入了136例PTB患者和57例ETB患者，微生物学确诊率分别为93.4%和52.6%，年发病率中位数分别为每10万居民7.5例和3.1例。总体而言，PTB患者比ETB患者更年轻，男性比例更高。PTB的危险因素包括吸烟（AOR = 3.98；95%置信区间[CI] = 1.66 - 9.56）、社会问题（社会边缘化、无家可归、居住在穷人收容所或入狱）（AOR = 3.39；95% CI = 1.05 - 10.94）以及与结核病患者接触（AOR = 2.51；95% CI = 1.06 - 5.95）。不吸烟和不滥用药物的相互作用降低了PTB风险（AOR = 0.27；95% CI = 0.12 - 0.64）。基于这些结果，可以采取具体的健康促进和预防措施。
PTB的估计相关因素是可以预防的，并且证明病例对照设计在结核病研究中是有用的。
