Gopie F A, Hassankhan A, Ottevanger S, Krishnadath I, de Lange W, Zijlmans C W R, Vreden S
Pulmonologist, Academic Hospital Paramaribo, Paramaribo, Suriname.
Anton de Kom University of Suriname, Faculty of Medical Sciences, Paramaribo, Suriname.
J Clin Tuberc Other Mycobact Dis. 2021 Mar 10;23:100227. doi: 10.1016/j.jctube.2021.100227. eCollection 2021 May.
In Suriname, a country home to many ethnic groups, a high incidence of tuberculosis (TB) has been found among Indigenous Trio Amerindians. However, whether wider ethnic disparities in TB incidence and its associated risk factors (e.g., diabetes mellitus and HIV) exist in Suriname, is not known. We sought to investigate disparities in TB incidence and its risk factors on ethnicity in Suriname, as this could give way to targeted TB intervention programs.
Anonymized patient data from 2011 to 2015 was extracted from the National TB Registry and analyzed. Differences in the five-year incidence rates of TB for the six largest ethnic groups-Creole, Hindustani, Indigenous, Javanese, Maroon, and Mixed-were assessed using a chi-square goodness-of-fit test, and TB patient differences regarding ethnicity were evaluated for selected factors using a multinomial logistic regression with Creole patients as reference.
662 Patients were eligible for analyses with the following ethnic makeup: Creole (36.4%), Hindustani (15.6%), Indigenous (8.6%), Javanese (10.6%), Maroon (15.1%), and Mixed ethnicity (13.7%). Differences in five-year incidence rates for TB were significant, (5, N = 662) = 244.42, < .001, and the highest TB rates were found for Indigenous (280 per 100,000) and Creole people (271 per 100,000). HIV coinfection was a TB risk factor for Creoles (38.2% of these patients were HIV positive). Several variables (i.e., those for drug use) had high levels of incomplete or missing data.
Our study has demonstrated that ethnic disparities in tuberculosis incidence exist in Suriname and that they are associated with specific, known risk factors such as HIV (especially for Creole people). For Indigenous people, risk factors may include diminished access to health care facilities and low socioeconomic status. However, direct data on these factors was unavailable. These findings call for targeted national intervention programs-with special attention given to the vulnerabilities of susceptible ethnic groups-and improved data collection.
在苏里南这个拥有众多民族的国家，已发现本土特里奥美洲印第安人中结核病（TB）发病率很高。然而，苏里南是否存在更广泛的结核病发病率及其相关风险因素（如糖尿病和艾滋病毒）方面的种族差异尚不清楚。我们试图调查苏里南结核病发病率及其风险因素在种族方面的差异，因为这可能为有针对性的结核病干预项目提供依据。
从国家结核病登记处提取并分析了2011年至2015年的匿名患者数据。使用卡方拟合优度检验评估六个最大种族——克里奥尔人、印度斯坦人、原住民、爪哇人、马龙人以及混血人种——的五年结核病发病率差异，并以克里奥尔患者为参照，通过多项逻辑回归分析选定因素下不同种族结核病患者的差异。
662名患者符合分析条件，其种族构成如下：克里奥尔人（36.4%）、印度斯坦人（15.6%）、原住民（8.6%）、爪哇人（10.6%）、马龙人（15.1%）和混血人种（13.7%）。结核病五年发病率差异显著，χ²(5, N = 662) = 244.42，P <.001，原住民（每10万人中280例）和克里奥尔人（每10万人中271例）的结核病发病率最高。艾滋病毒合并感染是克里奥尔人的结核病风险因素（这些患者中有38.2%艾滋病毒呈阳性）。几个变量（即吸毒相关变量）存在大量不完整或缺失数据。
我们的研究表明，苏里南存在结核病发病率的种族差异，且这些差异与特定的已知风险因素有关，如艾滋病毒（特别是对克里奥尔人而言）。对于原住民来说，风险因素可能包括获得医疗保健设施的机会减少和社会经济地位较低。然而，关于这些因素的直接数据并不存在。这些发现呼吁实施有针对性的国家干预项目——特别关注易感种族群体的脆弱性——并改进数据收集工作。
