Kobayashi Nobuaki, Matsumoto Hiromi, Kaneko Takeshi
Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan.
J Clin Tuberc Other Mycobact Dis. 2024 Nov 22;37:100497. doi: 10.1016/j.jctube.2024.100497. eCollection 2024 Dec.
To investigate regional variations in pyrazinamide (PZA) prescribing across Japan's 47 prefectures and associated influential factors.
This study utilized the Standardized Claim Ratio (SCR) for PZA from Japan's National Database of Health Insurance Claims in 2018. Pearson's correlation coefficients assessed relationships between SCR and tuberculosis (TB) incidence, patient characteristics (age, liver disease), and healthcare resources (specialists, TB beds). Multiple regression analysis identified independent predictors of SCR.
Median SCR for PZA was 90.0 (range 40.2-187.1), with a 3-fold difference between top and bottom prefectures. In univariate analysis, SCR correlated positively with TB incidence (r = 0.42), respiratory/infectious disease/TB specialists, and negatively with elderly TB patients (r = -0.33) and liver disease per TB case. Multiple regression revealed higher SCR associated with higher TB incidence (β = 0.44, p < 0.001), lower elderly patients (β = -0.33, p = 0.005), and more respiratory specialists (β = 0.41, p < 0.001).
Regional PZA prescription patterns are multifaceted, significantly influenced by TB prevalence, elderly patient ratios, and the availability of respiratory specialists. To enhance PZA prescribing conformity and TB management, fostering respiratory expertise across Japan is imperative.
调查日本47个都道府县吡嗪酰胺（PZA）处方的地区差异及相关影响因素。
本研究使用了2018年日本全国健康保险理赔数据库中PZA的标准化理赔率（SCR）。Pearson相关系数评估了SCR与结核病（TB）发病率、患者特征（年龄、肝病）和医疗资源（专科医生、结核病床位）之间的关系。多元回归分析确定了SCR的独立预测因素。
PZA的SCR中位数为90.0（范围40.2 - 187.1），最高和最低的都道府县之间相差3倍。在单因素分析中，SCR与TB发病率（r = 0.42）、呼吸/感染性疾病/TB专科医生呈正相关，与老年TB患者（r = -0.33）和每例TB病例中的肝病呈负相关。多元回归显示，SCR较高与TB发病率较高（β = 0.44，p < 0.001）、老年患者较少（β = -0.33，p = 0.005）和呼吸专科医生较多（β = 0.41，p < 0.001）有关。
地区PZA处方模式是多方面的，受TB患病率、老年患者比例和呼吸专科医生可用性的显著影响。为提高PZA处方的一致性和TB管理水平，在日本培养呼吸专业知识势在必行。
