基于多中心调查数据和空间统计模型的全国结核分枝杆菌潜伏感染率估算

目的: 估算全国结核分枝杆菌潜伏感染率,为我国结核病综合防控策略提供依据。方法: 综合2013年多中心的基于γ-干扰素释放试验的结核分枝杆菌潜伏感染流行病学调查数据和2013—2019年全国各县(区)肺结核报告发病率等多源数据,基于三位一体空间统计框架利用纠偏空间统计推断模型(Biased Sample Hospital-based Area Disease Estimation,B-SHADE)估算全国结核分枝杆菌潜伏感染率。利用交叉验证法和两个新增研究现场的调查数据进行精度验证。结果: 2013年,我国5岁及以上人群结核分枝杆菌潜伏感染率为18.08%(95%CI:13.73%~22.42%);15岁及以上人群结核分枝杆菌潜伏感染率为20.34%(95%CI:15.63%~25.06%),呈现出随着年龄增长而升高的趋势,男性潜伏感染率24.02%(95%CI:18.27%~29.77%)]高于女性16.91%(95%CI:12.13%~21.70%)]。B-SHADE模型对两个新增验证点估计结果的平均绝对误差为0.95%。结论: 基于多中心的流行病学调查结果和B-SHADE的全国结核分枝杆菌潜伏感染率估算填补了近年来相关全国性数据的空缺,将为我国适时加强结核分枝杆菌潜伏感染重点人群预防干预、完善“预防为主”的防控策略提供数据依据。

Estimation of the national burden on latent tuberculosis infection based a multi-center epidemiological survey and the space statistics model

Objective:To estimate the prevalence of latent tuberculosis infection(LTBI)in China,which would provide essential evidence for improving the comprehensive strategy of tuberculosis(TB)control.Methods:The data of multi-center LTBI epidemiological survey in 2013 and the nationwide incidence of reported TB by counties between 2013-2019 were collected,and the prevalence of LTBI was estimated by using the Biased Sample Hospital-based Area Disease Estimation(B-SHADE).The accuracy was verified by using cross validation method with the survey data of two additional study sites.Results:In 2013,the prevalence of LTBI in people 5 years old and above was 18.08%(95%CI:13.73%-22.42%)and in people 15 years old and above was 20.34%(95%CI:15.63%-25.06%),respectively.The LTBI prevalence showed a trend of increasing with age and it was significantly higher in men(24.02%(95%CI:18.27%-29.77%))than that in women(16.91%(95%CI:12.13%-21.70%))at 15 years old and above group.The average absolute error of the estimations of two additional verification sites by B-SHADE model was found to be 0.95%.Conclusion:The prevalence of LTBI estimated by using the results of multi-center epidemiological survey and B-SHADE method makes up the lack of relevant data in recent years,which will provide evidence for China to timely strengthen LTBI management in target populations and to improve the prevention based TB control strategy.