Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia.
Extra-pulmonary Research Unity, Hedi Chaker University Hospital, Sfax, Tunisia; Department of Preventive Medicine and Hospital Hygiene, Hedi Chaker University Hospital, Sfax, Tunisia.
Respir Med Res. 2020 Mar;77:67-71. doi: 10.1016/j.resmer.2020.02.002. Epub 2020 Feb 11.
Despite the wide use of anti-tuberculosis drugs, pulmonary tuberculosis (PTB) remains one of the most important causes of mortality and morbidity, particularly in developing countries. Therefore, combining clinical and epidemiological approach would be of a great benefit. Our study aimed to describe the epidemiological and clinical specificities of PTB and its recent chronological trends.
We conducted a retrospective study of all PTB new cases of any age diagnosed between 1995 and 2016 in Southern Tunisia. We applied the direct method of age-standardization using the World Standard Population to compute the age standardized incidence rate (ASIR) and the age standardized mortality rate (ASMR) per 100 000 inhabitants.
We recorded 1121 new cases with PTB among 2771 new cases of tuberculosis (40.5%). The ASIR of PTB was 5.3/100 000 inhabitants/year and didn't change over the study period (rho=0.3; P=0.2). Patients with PTB were mainly aged between 15 and 59 years (n=861; 76.8%) and came from urban areas (n=600; 55%). The median duration of treatment was 7.6 months (IQR=[6-8 months]). Successful outcome was notified in 1075 cases (95.9%). Forty-one patients died yielding an ASMR of 0.18/100 000 inhabitants/year. Factors statistically associated with unsuccessful outcome included age≥60 years (OR=5; P<0.001) and shorter treatment duration (6.15 months vs 7.76 months; P<0.001).
In contrast to the decline in the global PTB incidence reported worldwide and in the neighboring countries, our study revealed no significant change in the PTB rates from 1995 to 2016. Therefore, tools and strategies used to manage PTB should be strengthened by a substantial effort in both basic science and epidemiology to have better incidence curves.
尽管抗结核药物广泛应用，肺结核（PTB）仍然是最重要的死亡和发病原因之一，特别是在发展中国家。因此，结合临床和流行病学方法将是非常有益的。我们的研究旨在描述 PTB 的流行病学和临床特征及其最近的时间趋势。
我们对 1995 年至 2016 年间在突尼斯南部诊断的所有年龄的 PTB 新病例进行了回顾性研究。我们应用世界标准人口的直接年龄标准化方法来计算每 100000 名居民的年龄标准化发病率（ASIR）和年龄标准化死亡率（ASMR）。
我们记录了 2771 例结核病新病例中有 1121 例肺结核（40.5%）。PTB 的 ASIR 为 5.3/100000 居民/年，在研究期间没有变化（rho=0.3；P=0.2）。PTB 患者主要年龄在 15 至 59 岁之间（n=861；76.8%），来自城市地区（n=600；55%）。治疗的中位数持续时间为 7.6 个月（IQR=[6-8 个月]）。1075 例（95.9%）通知了治疗成功。41 例患者死亡，ASMR 为 0.18/100000 居民/年。统计学上与治疗失败相关的因素包括年龄≥60 岁（OR=5；P<0.001）和治疗持续时间较短（6.15 个月比 7.76 个月；P<0.001）。
与全球范围内和邻国报道的全球肺结核发病率下降相反，我们的研究显示，1995 年至 2016 年期间，肺结核率没有显著变化。因此，应通过在基础科学和流行病学方面做出巨大努力来加强管理肺结核的工具和策略，以获得更好的发病率曲线。
