兴衰更迭：1991年至1994年美国的结核病情况
The fall after the rise: Tuberculosis in the United States, 1991 through 1994.
作者信息
McKenna M T, McCray E, Jones J L, Onorato I M, Castro K G
机构信息
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Ga. 30333, USA.
出版信息
Am J Public Health. 1998 Jul;88(7):1059-63. doi: 10.2105/ajph.88.7.1059.
OBJECTIVES
Factors associated with decreases in tuberculosis cases observed in the United States in 1993 and 1994 were analyzed.
METHODS
Changes in case counts reported to the national surveillance system were evaluated by dividing the number of incident cases of TB reported in 1993 and 1994 by the number of cases reported in 1991 and 1992 and stratifying these ratios by demographic factors, AIDS incidence, and changes in program performance.
RESULTS
Case counts decreased from 52,956 in 1991 and 1992 to 49,605 in 1993 and 1994 (case count ratio = 0.94, 95% confidence interval [CI] = 0.93, 0.95). The decrease, confined to US-born patients, was generally associated with AIDS incidence and improvements in completion of therapy, conversion of sputum, and increases in the number of contacts identified per case.
CONCLUSIONS
Recent TB epidemiology patterns suggest that improvements in treatment and control activities have contributed to the reversal in the resurgence of this disease in US-born persons. Continued success in preventing the occurrence of active TB will require sustained efforts to ensure appropriate treatment of cases.
目的
分析与1993年和1994年美国结核病病例数下降相关的因素。
方法
通过将1993年和1994年报告的结核病新发病例数除以1991年和1992年报告的病例数，并按人口统计学因素、艾滋病发病率和项目执行情况的变化对这些比率进行分层，评估向国家监测系统报告的病例数变化。
结果
病例数从1991年和1992年的52,956例降至1993年和1994年的49,605例（病例数比率 = 0.94，95%置信区间[CI] = 0.93, 0.95）。这种下降仅限于美国出生的患者，通常与艾滋病发病率以及治疗完成率、痰菌转阴率的提高和每例患者发现的接触者数量增加有关。
结论
近期结核病流行病学模式表明，治疗和控制活动的改善有助于扭转美国出生人群中这种疾病的再次流行。要持续成功预防活动性结核病的发生，需要持续努力以确保对病例进行适当治疗。
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