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监禁率的上升导致监狱中的结核病负担不断增加,并危及巴拉圭的整体结核病控制。

Increased incarceration rates drive growing tuberculosis burden in prisons and jeopardize overall tuberculosis control in Paraguay.

机构信息

Instituto de Salud Global de Barcelona (ISGLOBAL), Barcelona, Spain.

Programa Nacional de Control de la Tuberculosis, Asunción, Paraguay.

出版信息

Sci Rep. 2020 Dec 4;10(1):21247. doi: 10.1038/s41598-020-77504-1.

Abstract

Incarcerated populations are at high-risk to develop tuberculosis (TB), however their impact on the population-level tuberculosis epidemic has been scarcely studied. We aimed to describe the burden and trends of TB among incarcerated populations over time in Paraguay, its clinical and epidemiological differences and the population attributable fraction. This is an observational, descriptive study including all TB cases notified to the National TB control Program in Paraguay during the period 2009-2018. We also used case registries of prisoners diagnosed with tuberculosis from the Minister of Justice. The population attributable fraction of TB in the community due to incarcerated cases was estimated through Levin's formula. The characteristics of TB cases in and outside of prison were compared as well as the characteristics of TB in prisons were modified over time. During 2009-2018, 2764 (9.7%) of the 28,534 TB reported cases in Paraguay occurred in prisons. The number of prisoners in Paraguay increased from 6258 in 2009 to 14,627 in 2018 (incarceration rate, 101 to 207 per 100,000 persons) while the number of TB cases among prisoners increased by 250% (n = 192 in 2009 versus n = 480 in 2018). The annual TB notification rate among male prisoners was 3218 and 3459 per 100,000 inmates in 2009 and 2018, respectively. The percentage of all TB cases occurring among prisoners increased from 7.1% in 2009 to 14.5% in 2018. The relative risk of TB in prisons compared to community was 70.3 (95% CI, 67.7-73.1); the overall population attributable risk was 9.5%. Among the 16 penitentiary centers in the country, two of them-Tacumbú (39.0%) and Ciudad del Este (23.3%)-represent two thirds of all TB cases in prisons. TB among inmates is predominantly concentrated in those 20-34 years old (77.3% of all), twice the percentage of cases for the same age group outside of prison. Our findings show that the TB epidemic in prisons represents one of the most important challenges for TB control in Paraguay, especially in the country's largest cities. Appropriate TB control measures among incarcerated populations are needed and may have substantial impact on the overall TB burden in the country.

摘要

被监禁人群患结核病(TB)的风险很高,但他们对人群结核病流行的影响却鲜有研究。我们旨在描述 2009 年至 2018 年期间巴拉圭被监禁人群中结核病的负担和趋势,以及其临床和流行病学差异和人群归因分数。这是一项观察性、描述性研究,包括巴拉圭国家结核病控制规划期间报告的所有结核病病例。我们还使用了司法部囚犯结核病病例登记处的数据。通过 Levin 公式估计了因监禁病例而导致社区结核病的人群归因分数。比较了监狱内外结核病病例的特征,并随着时间的推移修改了监狱内结核病的特征。2009 年至 2018 年期间,巴拉圭报告的 28534 例结核病病例中有 2764 例(9.7%)发生在监狱中。巴拉圭的囚犯人数从 2009 年的 6258 人增加到 2018 年的 14627 人(监禁率为每 10 万人 101 至 207 人),而囚犯中的结核病病例增加了 250%(2009 年为 192 例,2018 年为 480 例)。2009 年和 2018 年,男性囚犯的年结核病发病率分别为每 10 万囚犯 3218 例和 3459 例。2009 年和 2018 年,囚犯中所有结核病病例的比例分别从 7.1%增加到 14.5%。与社区相比,监狱中的结核病相对风险为 70.3(95%CI,67.7-73.1);总人群归因风险为 9.5%。在该国的 16 个监狱中心中,其中两个-Tacumbú(39.0%)和 Ciudad del Este(23.3%)-占监狱中所有结核病病例的三分之二。囚犯中的结核病主要集中在 20-34 岁的人群(占所有病例的 77.3%),是监狱外同年龄组病例的两倍。我们的研究结果表明,监狱中的结核病疫情是巴拉圭结核病控制的最重要挑战之一,尤其是在该国最大的城市。需要对被监禁人群采取适当的结核病控制措施,这可能对该国的整体结核病负担产生重大影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/98af/7718226/bf3f591f473a/41598_2020_77504_Fig1_HTML.jpg

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