2014—2019年广州市涂阳肺结核患者流行特征分析

目的 分析2014—2019年广州市涂阳肺结核患者流行病学特征,为制定肺结核防治措施提供科学依据。 方法 通过《中国疾病预防控制信息系统》的子系统《结核病信息管理系统》,收集广州市2014—2019年登记的24344例涂阳肺结核患者的信息,包括户籍、性别、职业、患者发现方式、治疗分类等,应用季节指数对时间序列进行季节效应分析,应用莫兰指数(Moran I)对地理信息作全局空间自相关分析。 结果 2014—2019年广州市涂阳肺结核年均登记率为28.53/10万(24344/8533.38万);各区年均登记率在20.49/10万~43.74/10万,平均登记率呈现“西高东低”的特征;越秀区涂阳肺结核年均登记率最高(43.74/10万,3069/701.68万);广州市涂阳肺结核总登记率由2014年的38.39/10万(5022/1308.05万)下降至2019年的21.39/10万(3274/1530.59万),差异有统计学意义($x^{2}_{趋势}$=1110.440,P<0.01)。涂阳肺结核患者中,男17331例,女7013例,男女比例为2.47∶1;流动人口占比由2014年的30.19%(1516/5022)上升至2019年的47.62%(1559/3274),差异有统计学意义($x^{2}_{趋势}$=12.197,P<0.01);职业以家政待业占比最高,为36.59%(8908/24344);因症就诊是发现涂阳肺结核患者的主要方式,占48.66%(11846/24344);复治患者涂阳率达68.16%(2894/4246)。涂阳肺结核流行期为每年的1月(季节指数为110.40)和3~8月(季节指数为分别为108.00、105.70、112.90、104.50、110.40、106.90);全局空间自相关分析发现,广州市涂阳肺结核患者整体无空间聚集性(2014—2019年Moran I值分别为-0.180、-0.160、0.180、0.141、-0.097和-0.095,Z值分别为-0.440、-0.391、1.382、1.038、-0.006和0.032,P值分别为0.374、0.393、0.101、0.158、0.472和0.463)。 结论 广州市涂阳肺结核整体流行水平呈下降趋势,涂阳肺结核呈现季节变化规律,不同地区的涂阳肺结核流行情况不同,应将流动人口作为肺结核防治的重点人群。

Analysis of epidemiological characteristics of smear-positive tuberculosis patients in Guangzhou from 2014 to 2019

Objective To analyze the epidemiological characteristics of smear-positive pulmonary tuberculosis patients in Guangzhou from 2014 to 2019,and to provide scientific evidence for development of pulmonary tuberculosis prevention and control measures.Methods The information of 24344 smear-positive pulmonary tuberculosis patients registered in Guangzhou from 2014 to 2019 was collected through the subsystem"Tuberculosis Information Management System"of the"China Disease Prevention and Control Information System",including household registration,gender,occupation,case detection channel and treatment category,etc.Seasonal index was applied to analyze the seasonal effect of time series,and Moran index was applied to analyze the global spatial autocorrelation of geographic information.Results The average annual registration rate of smear-positive tuberculosis in Guangzhou from 2014 to 2019 was 28.53/100000(24344/85.3338 million),and the average annual registration rate in each district was 20.49/100000 to 43.74/100000.The average registration rate performed"high in the west and low in the east".The annual average registration rate of smear-positive tuberculosis in Yuexiu District was the highest(43.74/100000(3069/7.0168 million)).The total registration rate decreased from38.39/100000(5022/13.0805 million)in 2014 to 21.39/100000(3274/15.3059 million)in 2019 with a significant trend(χt2 rend=1110.440,P<0.01).Among the smear-positive pulmonary tuberculosis patients,there were 17331 male patients and 7013 female patients,with a male-female ratio of 2.47∶1;the proportion of the transient population increased year by year(χt2 rend=12.197,P<0.01),from 30.19%(1516/5022)in 2014 to 47.62%(1559/3274)in 2019;domestic workers accounted for the highest proportion of occupations,which was 36.59%(8908/24344);medical consultation was the main way to find smear-positive tuberculosis patients,accounting for48.66%(11846/24344);the smear-positive rate of retreated patients reached 68.16%(2894/4246).The prevalence of smear-positive pulmonary tuberculosis was January(with the seasonal index 110.40)and March to August(seasonal indexes were 108.00,105.70,112.90,104.50,110.40 and 106.90 respectively)each year;global spatial autocorrelation analysis showed that there was no spatial clustering of smear-positive pulmonary tuberculosis patients in Guangzhou as a whole(Moran Ivalues from 2014 to 2019 were-0.180,-0.160,0.180,0.141,-0.097 and-0.095,Zvalues were-0.440,-0.391,1.382,1.038,-0.006 and 0.032,Pvalues were0.374,0.393,0.101,0.158,0.472 and 0.463,respectively).Conclusion The overall prevalence of smearpositive pulmonary tuberculosis in Guangzhou is on a downward trend,and smear-positive pulmonary tuberculosis registration presents a seasonal variation.The prevalence of smear-positive pulmonary tuberculosis in different regions is different,and the transient population should be regarded as the key population for tuberculosis control.