Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
Department of Tuberculosis, Center for Disease Control and Prevention of Sichuan Province, Chengdu, China.
JMIR Public Health Surveill. 2023 Jan 13;9:e40659. doi: 10.2196/40659.
While the End Tuberculosis (TB) Strategy has been implemented worldwide, the cause of the TB epidemic is multifactorial and not fully understood.
This study aims to investigate the risk factors of TB and incorporate these factors to forecast the incidence of TB infection across different age groups in Sichuan, China.
Correlation and linear regression analyses were conducted to assess the relationships between TB cases and ecological factors, including environmental, economic, and social factors, in Sichuan Province from 2006 to 2017. The transfer function-noise model was used to forecast trends, considering both time and multifactor effects.
From 2006 to 2017, Sichuan Province had a reported cumulative incidence rate of 1321.08 cases per 100,000 individuals in male patients and 583.04 cases per 100,000 individuals in female patients. There were significant sex differences in the distribution of cases among age groups (trend χ=12,544.4; P<.001). Ganzi Tibetan Autonomous Prefecture had the highest incidence rates of TB in both male and female patients in Sichuan. Correlation and regression analyses showed that the total illiteracy rate and average pressure at each measuring station (for individuals aged 15-24 years) were risk factors for TB. The protective factors were as follows: the number of families with the minimum living standard guarantee in urban areas, the average wind speed, the number of discharged patients with invasive TB, the number of people with the minimum living standard guarantee in rural areas, the total health expenditure as a percentage of regional gross domestic product, and being a single male individual (for those aged 0-14 years); the number of hospitals and number of health workers in infectious disease hospitals (for individuals aged 25-64 years); and the amount of daily morning and evening exercise, the number of people with the urban minimum living standard guarantee, and being married (for female individuals aged ≥65 years). The transfer function-noise model indicated that the incidence of TB in male patients aged 0-14 and 15-24 years will continue to increase, and the incidence of TB in female patients aged 0-14 and ≥65 years will continue to increase rapidly in Sichuan by 2035.
The End TB Strategy in Sichuan should consider environmental, educational, medical, social, personal, and other conditions, and further substantial efforts are needed especially for male patients aged 0-24 years, female patients aged 0-14 years, and female patients older than 64 years.
尽管全球范围内已经实施了终结结核病（TB）策略，但结核病流行的原因是多因素的，尚未完全了解。
本研究旨在调查结核病的危险因素，并将这些因素纳入预测中国四川不同年龄组结核病感染发病率的模型中。
对 2006 年至 2017 年四川省结核病病例与环境、经济和社会等生态因素之间的关系进行了相关性和线性回归分析。考虑到时间和多因素的影响，使用传递函数-噪声模型进行趋势预测。
2006 年至 2017 年，四川省男性患者的累积发病率为每 10 万人 1321.08 例，女性患者为每 10 万人 583.04 例。各年龄组病例分布存在显著的性别差异（趋势 χ²=12544.4；P<.001）。甘孜藏族自治州在四川省男性和女性患者中的结核病发病率均最高。相关性和回归分析表明，总文盲率和每个测量站的平均压力（15-24 岁人群）是结核病的危险因素。保护因素包括：城市地区最低生活保障家庭数、平均风速、传染性肺结核患者出院人数、农村地区最低生活保障人数、卫生总费用占地区生产总值的百分比和单身男性（0-14 岁人群）；医院数量和传染病医院卫生人员数量（25-64 岁人群）；以及早晚运动量、城市最低生活保障人数和已婚人数（≥65 岁女性人群）。传递函数-噪声模型表明，四川省 0-14 岁和 15-24 岁男性患者的结核病发病率将继续上升，而四川省 0-14 岁和≥65 岁女性患者的结核病发病率将在 2035 年前继续快速上升。
四川省的终结结核病策略应考虑环境、教育、医疗、社会、个人等条件，并需要进一步加大力度，特别是针对 0-24 岁的男性患者、0-14 岁的女性患者和 64 岁以上的女性患者。
