Zhou Yiqing, Wang Fei, Chen Songhua, Zhang Yu, Wang Wei, Wu Qian, Luo Dan, Ling Yuxiao, Li Yang, Wang Luyu, Wei Jingru, Chen Bin, Zhang Canyou, Liu Kui
School of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang, China.
Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
BMC Public Health. 2024 Dec 20;24(1):3551. doi: 10.1186/s12889-024-21019-1.
The elderly population is a high-risk group for tuberculosis, and increasing evidence demonstrates a comparatively high proportion of asymptomatic tuberculosis in this group. This study aimed to determine the proportion of asymptomatic tuberculosis among patients with active tuberculosis through active case finding in the elderly population.
We searched for relevant articles published from the establishment of each database to December 31, 2023 in Web of Science, PubMed, VIP database, Chinese National Knowledge Infrastructure, and Wanfang database. The studies' quality was assessed using the Agency for Healthcare Research and Quality's criteria. We used the I² statistic and Q test to evaluate heterogeneity across the included studies. We employed subgroup analysis, sensitivity analysis, and meta-regression to pinpoint sources of heterogeneity. Moreover, Begg's and Egger's tests were employed to detect any potential publication biases.
Nine studies involving 364,260 elderly individuals met the criteria for the analysis. In active case finding, the proportion of asymptomatic tuberculosis in the elderly population was 67.7% (95% CI: 54.7-79.5%, I = 90.197, P < 0.001). The subgroup analysis revealed that the proportion of asymptomatic tuberculosis in high-burden countries was high, at 66.3% (95%CI: 52.5-78.9%, P < 0.001). Studies using multiple screening strategies including chest X-ray showed a higher percentage of asymptomatic patients, at 67.6% (95% CI: 51.1-82.1%, P < 0.001). However, in studies conducted after 2019 and studies with large sample sizes (≥ 15,000), the proportion of asymptomatic tuberculosis decreased (54.3%, 95%CI: 48.6-60.1%; and 62.3%, 95%CI: 45.9-77.4%, respectively).
The latest results revealed a significantly high percentage of elderly individuals with asymptomatic tuberculosis. This study highlighted the importance of mass screening to identify active tuberculosis cases in this specific group which could help health policymakers develop better strategies to reduce the burden of tuberculosis in the elderly population.
老年人群是结核病的高危群体，越来越多的证据表明该群体中无症状结核病的比例相对较高。本研究旨在通过在老年人群中开展主动病例发现来确定活动性结核病患者中无症状结核病的比例。
我们检索了Web of Science、PubMed、维普数据库、中国知网和万方数据库中从各数据库建立至2023年12月31日发表的相关文章。使用医疗保健研究与质量局的标准评估研究质量。我们使用I²统计量和Q检验来评估纳入研究间的异质性。我们采用亚组分析、敏感性分析和Meta回归来确定异质性来源。此外，采用Begg检验和Egger检验来检测任何潜在的发表偏倚。
9项涉及364,260名老年人的研究符合分析标准。在主动病例发现中，老年人群中无症状结核病的比例为67.7%（95%CI：54.7 - 79.5%，I = 90.197，P < 0.001）。亚组分析显示，高负担国家无症状结核病的比例较高，为66.3%（95%CI：52.5 - 78.9%，P < 0.001）。使用包括胸部X线在内的多种筛查策略的研究显示无症状患者的比例更高，为67.6%（95%CI：51.1 - 82.1%，P < 0.001）。然而，在2019年后开展的研究和大样本量（≥15,000）的研究中，无症状结核病的比例有所下降（分别为54.3%，95%CI：48.6 - 60.1%；和62.3%，95%CI：45.9 - 77.4%）。
最新结果显示老年无症状结核病患者的比例显著较高。本研究强调了大规模筛查在识别这一特定群体中活动性结核病例的重要性，这有助于卫生政策制定者制定更好的策略来减轻老年人群的结核病负担。
