Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, China.
Department of Tuberculosis Prevention and Control, Guizhou Center for Disease Prevention and Control, Guiyang, Guizhou, China.
BMC Public Health. 2024 Feb 20;24(1):526. doi: 10.1186/s12889-024-18023-w.
Understanding the trends of tuberculosis (TB) burden and its risk factors at the provincial level in the context of global End TB targets is crucial to identify the progress and challenges in TB control. We aimed to estimate the burden of TB and risk factors for death from 2006 to 2020 for the first time in Guizhou Province, China.
Data were collected from the national TB surveillance system. Four indicators of TB burden and their corresponding age-standardized rates (ASRs), including incidence (ASIR), prevalence (ASPR), mortality (ASMR) and disability-adjusted life years (DALYs) (ASDR), were estimated and stratified by year, age, gender and prefecture. Temporal trends of ASRs were presented by locally weighted regression, and the annual percentage change was calculated. The correlation between gross domestic product (GDP) per capita and ASRs was evaluated by Pearson correlation analysis. The associated risk factors for death in PTB patients were determined using logistic regression models.
A total of 557,476 pulmonary TB (PTB) cases and 11,234 deaths were reported, including 2233 (19.9%) TB specific deaths and 9001 (80.1%) deaths from other causes. The 15-year average incidence, prevalence and mortality rates were 94.6, 102.6 and 2.1 per 100,000 population, respectively. The average DALY rate was 0.60 per 1000 population. The ASIR and ASPR have shown downward trends since 2012, with the largest percentage decrease in 2020 (ASIR: -29.8%; ASPR: -30.5%). The number in TB specific deaths consistently decreased during the study period (P<0.001), while the increase in deaths from other causes drove the overall upward trend in ASMR and ASDR. Four ASRs remained high in males and 5 prefectures. GDP per capita was negatively associated with the ASIR, ASPR and ASDR (P<0.05). Among PTB patients, men, patients with no fixed job, those with a low GDP level, patients with increasing age, those previously treated, those with severe symptoms, those transferred in and those receiving directly observed treatment were more likely to suffer death.
Guizhou has made progress in reducing PTB cases and TB specific deaths over the last 15 years. Targeted interventions are needed to address these risk factors for death in PTB patients and high-risk areas.
了解全球终结结核病目标背景下省级结核病负担及其危险因素的趋势，对于确定结核病控制的进展和挑战至关重要。本研究旨在首次评估贵州省结核病负担及其导致死亡的危险因素。
数据来自国家结核病监测系统。我们估算了结核病负担的四个指标及其相应的年龄标准化率（ASR），包括发病率（ASIR）、患病率（ASPR）、死亡率（ASMR）和伤残调整生命年（DALYs）（ASDR），并按年份、年龄、性别和地级市进行分层。通过局部加权回归呈现 ASR 的时间趋势，并计算年度变化百分比。通过皮尔逊相关分析评估人均国内生产总值（GDP）与 ASR 之间的相关性。采用 logistic 回归模型确定肺结核（PTB）患者死亡的相关危险因素。
共报告了 557476 例肺结核病例和 11234 例死亡，其中 2233 例（19.9%）为结核病特异性死亡，9001 例（80.1%）为其他原因死亡。15 年平均发病率、患病率和死亡率分别为 94.6、102.6 和 2.1/100000 人口。平均 DALY 率为 0.60/1000 人口。自 2012 年以来，ASIR 和 ASPR 呈下降趋势，2020 年降幅最大（ASIR：-29.8%；ASPR：-30.5%）。结核病特异性死亡人数在研究期间持续减少（P<0.001），而其他原因导致的死亡人数增加导致 ASMR 和 ASDR 呈总体上升趋势。4 个 ASR 在男性中仍较高，5 个地级市较高。人均 GDP 与 ASIR、ASPR 和 ASDR 呈负相关（P<0.05）。在肺结核患者中，男性、无固定职业者、低 GDP 水平者、年龄增长者、既往治疗者、症状严重者、转入者和接受直接观察治疗者更易死亡。
过去 15 年来，贵州省在减少肺结核病例和结核病特异性死亡方面取得了进展。需要针对这些肺结核患者死亡的危险因素和高风险地区采取有针对性的干预措施。
