Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Medical Data Research Collaborative, London, UK.
BMC Pulm Med. 2023 May 26;23(1):184. doi: 10.1186/s12890-023-02458-9.
Pulmonary tuberculosis (TB) is a major source of global morbidity and mortality. Latent infection has enabled it to spread to a quarter of the world's population. The late 1980s and early 1990s saw an increase in the number of TB cases related to the HIV epidemic, and the spread of multidrug-resistant TB. Few studies have reported pulmonary TB mortality trends. Our study reports and compares trends in pulmonary TB mortality.
We utilized the World Health Organization (WHO) mortality database from 1985 through 2018 to analyze TB mortality using the International Classification of Diseases-10 codes. Based on the availability and quality of data, we investigated 33 countries including two countries from the Americas; 28 countries from Europe; and 3 countries from the Western Pacific region. Mortality rates were dichotomized by sex. We computed age-standardized death rates per 100,000 population using the world standard population. Time trends were investigated using joinpoint regression analysis.
We observed a uniform decrease in mortality in all countries across the study period except the Republic of Moldova, which showed an increase in female mortality (+ 0.12 per 100,000 population). Among all countries, Lithuania had the greatest reduction in male mortality (-12) between 1993-2018, and Hungary had the greatest reduction in female mortality (-1.57) between 1985-2017. For males, Slovenia had the most rapid recent declining trend with an estimated annual percentage change (EAPC) of -47% (2003-2016), whereas Croatia showed the fastest increase (EAPC, + 25.0% [2015-2017]). For females, New Zealand had the most rapid declining trend (EAPC, -47.2% [1985-2015]), whereas Croatia showed a rapid increase (EAPC, + 24.9% [2014-2017]).
Pulmonary TB mortality is disproportionately higher among Central and Eastern European countries. This communicable disease cannot be eliminated from any one region without a global approach. Priority action areas include ensuring early diagnosis and successful treatment to the most vulnerable groups such as people of foreign origin from countries with a high burden of TB and incarcerated population. Incomplete reporting of TB-related epidemiological data to WHO excluded high-burden countries and limited our study to 33 countries only. Improvement in reporting is crucial to accurately identify changes in epidemiology, the effect of new treatments, and management approaches.
肺结核（TB）是全球发病率和死亡率的主要来源。潜伏感染使其传播到世界人口的四分之一。20 世纪 80 年代末和 90 年代初，与 HIV 流行相关的结核病病例以及耐多药结核病的传播有所增加。很少有研究报告肺结核死亡率趋势。我们的研究报告并比较了肺结核死亡率的趋势。
我们利用世界卫生组织（WHO）1985 年至 2018 年的死亡率数据库，使用国际疾病分类-10 代码分析结核病死亡率。根据数据的可用性和质量，我们调查了 33 个国家，包括两个来自美洲的国家；28 个来自欧洲的国家；和 3 个来自西太平洋地区的国家。根据性别将死亡率分为两类。我们使用世界标准人口计算了每 100,000 人口的标准化死亡率。使用 Joinpoint 回归分析研究了时间趋势。
除摩尔多瓦共和国（该国女性死亡率呈上升趋势，增加了 0.12/100,000 人口）外，我们观察到所有国家的死亡率在整个研究期间都呈均匀下降趋势。在所有国家中，立陶宛男性死亡率下降幅度最大（1993-2018 年下降 12），匈牙利女性死亡率下降幅度最大（1985-2017 年下降 1.57）。对于男性，斯洛文尼亚的近期下降趋势最快，估计年变化百分比（EAPC）为-47%（2003-2016 年），而克罗地亚的上升速度最快（EAPC，+25.0% [2015-2017 年]）。对于女性，新西兰的下降趋势最快（EAPC，-47.2% [1985-2015 年]），而克罗地亚的上升速度最快（EAPC，+24.9% [2014-2017 年]）。
肺结核死亡率在中欧和东欧国家中更高。如果没有全球方法，任何一个地区都无法消除这种传染病。优先行动领域包括确保最脆弱群体（例如来自结核病负担沉重国家的外国人和被监禁者）的早期诊断和成功治疗。向世界卫生组织报告结核病相关流行病学数据不完整，将高负担国家排除在外，使我们的研究仅限于 33 个国家。改进报告对于准确识别流行病学变化、新治疗效果和管理方法至关重要。
