Ruiz-Tornero Ana María, Sánchez-Recio Raquel
Servicio de Medicina Preventiva y Gestión de Calidad, Instituto de Investigación Sanitaria, Hospital General Universitario Gregorio Marañón. Madrid. España.
Grupo de Investigación en utilización de Servicios sanitarios en Aragón (GRISSA), Instituto de Investigación en Aragón, Universidad de Zaragoza. Zaragoza. España.
Rev Esp Salud Publica. 2022 Dec 2;96:e202212089.
There are different socioeconomic variables which determine tuberculosis's epidemiology, diagnosis and treatment. The objective of this paper was to analize these effects in the last years in Spain.
A systematic review was conducted. Screened studies were original articles written in English or Spanish and published between 2007 and 2020. Searching was performed in Pubmed and Web of Science databases. STROBE criteria were followed to analyze studies's quality, and studies included in the review had 15 points or more.
23 articles were selected, and were classified in different topics. Foreigners's proportion with tuberculosis changed in different autonomous communities between 10%-50%. There were diagnostic delay for this group compared to natives. This group had higher incidence of resistance to isoniazid, but without a clear increase in multidrug resistance. There were less adherence to tuberculosis's treatment in case of immigration, drug addiction, HIV coinfection, or lack of family support. Under-reporting of tuberculosis cases varied between 18%-28%, and it was higher in cases of social marginality, HIV coinfection, Spanish nationality or male sex. There were also other social risk groups in which the diagnostic approach to tuberculosis was relevant, such as in schools and health centers. Tuberculosis was one of the most frequent HIV associated diseases, although screening tests were not performed in almost 18%, depending on the concurrence of social risk factors.
Tuberculosis's incidence, diagnosis, and treatment are influenced by a lot of social and economic factors, which determine the approach to this disease.
有多种社会经济变量决定着结核病的流行病学、诊断和治疗。本文的目的是分析过去几年这些因素在西班牙所产生的影响。
进行了一项系统综述。筛选出的研究为2007年至2020年间发表的英文或西班牙文原创文章。在PubMed和科学网数据库中进行检索。遵循STROBE标准分析研究质量，纳入综述的研究得分为15分及以上。
共选取23篇文章，并分类为不同主题。不同自治区结核病患者中外国人的比例在10%至50%之间变化。与本地人相比，该群体存在诊断延迟。该群体对异烟肼的耐药发生率较高，但多重耐药并未明显增加。在移民、药物成瘾、合并感染艾滋病毒或缺乏家庭支持的情况下，对结核病治疗的依从性较低。结核病病例的漏报率在18%至28%之间，在社会边缘化、合并感染艾滋病毒、西班牙国籍或男性患者中漏报率更高。在学校和卫生中心等其他社会风险群体中，结核病的诊断方法也具有相关性。结核病是最常见的与艾滋病毒相关的疾病之一，不过根据社会风险因素的并发情况，近18%的病例未进行筛查检测。
结核病的发病率、诊断和治疗受到许多社会和经济因素的影响，这些因素决定了对该疾病的应对方式。
