印度尼西亚不同诊断方法和地理区域的结核病流行率变化。
Variation of tuberculosis prevalence across diagnostic approaches and geographical areas of Indonesia.
机构信息
Health Development Program, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Faculty of Public Health, Sriwijaya University, Kota Palembang, Sumatera Selatan, Indonesia.
出版信息
PLoS One. 2021 Oct 15;16(10):e0258809. doi: 10.1371/journal.pone.0258809. eCollection 2021.
BACKGROUND
Tuberculosis (TB) has contributed to a significant disease burden and economic loss worldwide. Given no gold standard for diagnosis, early identification of TB infection has been challenging. This study aimed to comparatively investigate the prevalence of TB across diagnostic approaches (sputum AFB, sputum culture, sputum genetic test, and chest x-ray) and geographical areas of Indonesia.
METHODS
Participant demographic variables and TB screening test results were obtained from the Tuberculosis Unit, Health Research and Development Agency, Ministry of Health (HRDA-MoH). The prevalence of pulmonary TB in populations aged 15 years and over was calculated using TB cases as a numerator and populations aged 15 years and over as a denominator. Variations across geographical areas and diagnostic approaches were expressed as prevalence and 95% confidence interval (CI).
RESULTS
A total of 67,944 records were reviewed. Based on bacteriological evidence, the prevalence of TB per 100,000 in Indonesia was 759 (95% CI: 589.7-960.8) with variations across areas: 913 (95% CI 696.7-1,176.7; Sumatra), 593 (95% CI 447.2-770.6; Java-Bali), and 842 (95% CI 634.7-1,091.8; other islands). Also, the prevalence of TB varied across diagnostic approaches: 256.5 (sputum AFB), 545 (sputum culture), 752.2 (chest x-ray), and 894.9 (sputum genetic test). Based on sputum AFB, the TB prevalence varied from 216.6 (95% CI 146.5-286.8; Java-Bali), 259.9 (95% CI 184.2-335.6; other islands) to 307.4 (95% CI 208.3-406.5; Sumatra). Based on sputum culture, the TB prevalence ranged from 487.9 (95% CI 433.6-548.6; Java-Bali), 635.9 (95% CI 564.9-715.1; Sumatra), to 2,129.8 (95% CI 1,664.0-2,735.6; other islands). Based on chest x-ray, the TB prevalence varied from 152.1 (95% CI 147.9-156.3; Java-Bali), 159.2 (95% CI 154.1-164.3; Sumatra), to 864 (95% CI 809-921.4; other islands). Based on sputum genetic test, the TB prevalence ranged from 838.7 (95% CI 748.4-900.8; Java-Bali), 875 (95% CI 775.4-934.2; Sumatra), to 941.2 (95% CI 663.6-992.3; other islands).
CONCLUSIONS
The variation of TB prevalence across geographical regions could be confounded by the diagnostic approaches.
TRIAL REGISTRATION
This study was approved by the Institutional Review Board of Chulalongkorn University (IRB No. 684/63).
背景
结核病（TB）在全球范围内造成了巨大的疾病负担和经济损失。由于缺乏诊断的金标准，早期发现 TB 感染一直具有挑战性。本研究旨在比较不同诊断方法（痰 AFB、痰培养、痰基因检测和胸部 X 光）和印度尼西亚不同地理区域的 TB 感染率。
方法
从卫生部健康研究与发展机构（HRDA-MoH）的结核病科获得参与者的人口统计学变量和 TB 筛查检测结果。将年龄在 15 岁及以上人群中的肺结核病例作为分子，年龄在 15 岁及以上人群作为分母，计算出肺结核的流行率。地理区域和诊断方法之间的差异以流行率和 95%置信区间（CI）表示。
结果
共审查了 67944 份记录。根据细菌学证据，印度尼西亚每 10 万人中 TB 的流行率为 759（95%CI：589.7-960.8），不同地区存在差异：913（95%CI 696.7-1176.7；苏门答腊岛），593（95%CI 447.2-770.6；爪哇岛-巴厘岛），842（95%CI 634.7-1091.8；其他岛屿）。此外，TB 的流行率也因诊断方法而异：256.5（痰 AFB），545（痰培养），752.2（胸部 X 光）和 894.9（痰基因检测）。根据痰 AFB，TB 的流行率从 216.6（95%CI 146.5-286.8；爪哇岛-巴厘岛），259.9（95%CI 184.2-335.6；其他岛屿）到 307.4（95%CI 208.3-406.5；苏门答腊岛）不等。根据痰培养，TB 的流行率范围从 487.9（95%CI 433.6-548.6；爪哇岛-巴厘岛），635.9（95%CI 564.9-715.1；苏门答腊岛）到 2129.8（95%CI 1664.0-2735.6；其他岛屿）不等。根据胸部 X 光，TB 的流行率从 152.1（95%CI 147.9-156.3；爪哇岛-巴厘岛），159.2（95%CI 154.1-164.3；苏门答腊岛）到 864（95%CI 809-921.4；其他岛屿）不等。根据痰基因检测，TB 的流行率从 838.7（95%CI 748.4-900.8；爪哇岛-巴厘岛），875（95%CI 775.4-934.2；苏门答腊岛）到 941.2（95%CI 663.6-992.3；其他岛屿）不等。
结论
TB 流行率在地理区域之间的差异可能因诊断方法的不同而混淆。
试验注册
本研究经朱拉隆功大学机构审查委员会（IRB No.684/63）批准。
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