Four decades of pulmonary tuberculosis in deceased South African miners: trends and determinants.
Four decades of pulmonary tuberculosis in deceased South African miners: trends and determinants.
复制标题
已故南非矿工四十年来的肺结核：趋势和决定因素。
DOI：
10.1136/oemed-2017-104806
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发表时间：
2018
影响因子：
4.9
通讯作者：
Murray,Jill
中科院分区：
文献类型：
--
作者：
Ndlovu,Ntombizodwa;Musenge,Eustasius;Park,SungKyun;Girdler-Brown,Brendan;Richards,Guy;Murray,Jill
目的我们调查了已故南非矿工的肺结核（PTB）趋势和决定因素。方法无论死因如何，对矿工进行法定尸检以获得职业性肺病补偿。数据从 PATHAUT（病理学自动化系统）尸检数据库中提取。使用二元逻辑回归模型分析了 PTB 趋势并评估了解释变量（尸检年份、死亡年龄、黄金就业持续时间、矽肺和 HIV）。由于社会经济地位、就业模式和尸检设施的使用情况存在种族差异，分析按人口群体进行分层。分析被分段以代表艾滋病毒前（1975-1989）、艾滋病毒快速传播（1990-2004）和抗逆转录病毒治疗（2005-2014）时期。 结果尸检时患有 PTB 的男性比例在黑人矿工中从 1975 年的 4.62% 增加到 2014 年的 27.18%，在黑人矿工中从 2.07% 增加到 2014 年。白人矿工的这一比例为 5.19%，在 2007 年达到峰值（分别为 43.12% 和 9.51%）。决定因素调整后的 OR 的大小和显着性因人口组和历期的不同而不同。 PTB 在很大程度上与硅肺病、增加黄金就业持续时间和尸检年份有关（不可测量的混杂因素的替代物，例如未知的艾滋病毒状况和结核病传播）。 结论 PTB 时间趋势和决定因素的变化反映了采矿发生的复杂社会和政治环境。减少二氧化硅粉尘以及结核病和艾滋病毒治疗和管理仍然是减少结核病的关键干预措施。尸检数据提供了可靠的信息，以监测实现行业和国家减少结核病目标的进展情况。
ObjectiveWe investigated trends and determinants of pulmonary tuberculosis (PTB) in deceased South African miners.MethodsStatutory autopsies are performed on miners for occupational lung disease compensation, irrespective of cause of death. Data were extracted from the PATHAUT (Pathology Automation System) autopsy database. PTB trends were analysed and explanatory variables (year of autopsy, age at death, gold employment duration, silicosis and HIV) were evaluated using binary logistic regression modelling. Analyses were stratified by population group because of racial differences in socioeconomic status, employment patterns and access to facilities for autopsies. The analyses were segmented to represent the pre-HIV (1975–1989), rapid HIV spread (1990–2004) and antiretroviral therapy (2005–2014) periods.ResultsThe proportions of men with PTB at autopsy increased from 4.62% in 1975 to 27.18% in 2014 in black miners, and from 2.07% to 5.19% in white miners, with peaks in 2007 (43.12% and 9.51%, respectively). The magnitude and significance of adjusted ORs of determinants differed by population group and calendar period. PTB was largely associated with silicosis, increasing gold employment duration and year of autopsy (a surrogate for unmeasured confounders, such as unknown HIV status and tuberculosis transmission).ConclusionsChanges in PTB time trends and determinants reflect the complex social and political environment in which mining occurs. Silica dust reduction remains a key intervention for tuberculosis reduction, together with tuberculosis and HIV treatment and management. The autopsy data provide reliable information to monitor progress towards the achievement of industry and national targets to reduce tuberculosis.