Department of Occupational Respiratory Disease, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100029, China.
Chin Med J (Engl). 2022 Dec 20;135(24):2984-2997. doi: 10.1097/CM9.0000000000002486.
Patients with pneumoconiosis have an elevated risk of contracting pulmonary tuberculosis (PTB) and need particular attention. However, extensive population-based studies on the prevalence of PTB in patients with pneumoconiosis have not been reported in China since 1992. This study aimed to investigate the epidemiological characteristics of PTB in patients with pneumoconiosis based on its social determinants and risk factors in China.
Based on the Commission on Social Determinants of Health (CSDH) framework, data were obtained from a questionnaire survey of patients with pneumoconiosis from China's 27 provinces (autonomous regions, municipalities) from December 2017 to June 2021. By chi-square and multivariate logistic regression analyses, the epidemiological characteristics of PTB in the patients were identified based on its prevalence and odds ratio (OR) and associated social determinants and risk factors. The population attributable fractions (PAFs) of significant risk factors were also calculated.
The prevalence of PTB in patients with pneumoconiosis ( n = 10,137) was 7.5% (95% confidence interval [CI]: 7.0-8.0%). Multivariate logistic regression analysis showed that risk factors included in-hospital exposure to patients with PTB (OR = 3.30, 95% CI: 2.77-3.93), clinically diagnosed cases (OR = 3.25, 95% CI: 2.42-4.34), and northeastern regions (OR = 2.41, 95% CI: 1.76-3.31). In addition, lack of work-related injury insurance (WRII), being born in a rural area, being unemployed, living in western regions, household exposure to patients with PTB, smoking, being underweight, complications of pulmonary bullae or pneumothorax, hospitalization history, and former drinkers among the rural patients were also statistically significant risk factors. Being born in a rural area, lack of WRII and in-hospital exposure to patients with PTB had higher PAFs, which were 13.2% (95% CI: 7.9-18.5%), 12.5% (95% CI: 8.3-16.7%), and 11.6% (95% CI: 8.8-14.3%), respectively.
The prevalence of PTB in pneumoconiosis remains high in China; it is basically in line with the CSDH models and has its characteristics.
尘肺病患者患肺结核（PTB）的风险增加，需要特别关注。然而，自 1992 年以来，中国尚未报道过针对尘肺病患者中 PTB 患病率的广泛基于人群的研究。本研究旨在根据中国的社会决定因素和危险因素，调查尘肺病患者中 PTB 的流行病学特征。
基于健康社会决定因素委员会（CSDH）框架，我们从 2017 年 12 月至 2021 年 6 月期间从中国 27 个省（自治区、直辖市）的尘肺患者问卷调查中获取数据。通过卡方检验和多变量逻辑回归分析，根据患病率和优势比（OR）以及相关社会决定因素和危险因素，确定患者中 PTB 的流行病学特征。还计算了显著危险因素的人群归因分数（PAF）。
尘肺病患者中 PTB 的患病率为 7.5%（95%置信区间：7.0-8.0%）。多变量逻辑回归分析表明，包括住院期间接触 PTB 患者（OR=3.30，95%置信区间：2.77-3.93）、临床诊断病例（OR=3.25，95%置信区间：2.42-4.34）和东北地区（OR=2.41，95%置信区间：1.76-3.31）在内的危险因素。此外，缺乏工作相关伤害保险（WRII）、农村出生、失业、西部地区居住、家庭接触 PTB 患者、吸烟、体重不足、肺大疱或气胸并发症、住院史以及农村患者中的既往饮酒者也是统计学上显著的危险因素。农村出生、缺乏 WRII 和住院期间接触 PTB 患者的 PAF 较高，分别为 13.2%（95%置信区间：7.9-18.5%）、12.5%（95%置信区间：8.3-16.7%）和 11.6%（95%置信区间：8.8-14.3%）。
中国尘肺病患者中 PTB 的患病率仍然很高；基本符合 CSDH 模型，并有其特点。
