Prevalence of pulmonary tuberculosis in western China in 2010-11: a population-based, cross-sectional survey
Prevalence of pulmonary tuberculosis in western China in 2010-11: a population-based, cross-sectional survey
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DOI：
10.1016/s2214-109x(16)30074-2
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发表时间：
2016-07-01
影响因子：
34.3
通讯作者：
Upur, Halmurat
中科院分区：
文献类型：
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作者：
Mijiti, Peierdun;Li Yuehua;Upur, Halmurat
背景中国西部地区结核病控制进展最慢，而西部地区是结核病流行率最高的地区。我们评估了肺结核病在新疆省，中国，10年后，介绍了控制计划的基础上，直接观察治疗，短期course.Methods在这个人口为基础的横断面调查，我们使用了多阶段分层随机整群抽样设计，以估计患病率的涂阳和细菌学证实在过去6个月内居住在其家庭的新疆成人（年龄≥ 15岁）中（涂片阳性或培养阳性，或两者兼有）肺结核。筛查策略和诊断遵循世卫组织指南。我们通过结合逆概率加权和缺失数据的多重插补来估计患病率。我们将我们的患病率调查估计值与2010年中国全国肺结核调查和2000年新疆省级肺结核调查的估计值进行了比较。结果2010年9月1日至2011年7月31日，新疆共调查31 081人，其中29 835人（96.0%）参加了调查。我们确定了50例（0.2%）涂片阳性和101例（0.3%）细菌学确诊的肺结核病例。涂阳肺结核加权患病率为170/10万（95%CI 103-233），细菌学确诊肺结核加权患病率为430/10万（95%CI 249-611）。与2000年新疆调查估计值相比，涂阳肺结核患病率下降了26.4%（从231 [95%CI 148-314]/10万人），而细菌学确诊的肺结核患病率上升了17.8%（从365 [237-493]/10万人）。2010- 2011年新疆调查各年龄组和性别肺结核患病率均高于2010年全国调查。2011年的PDR为0.34（95%CI 0.25-0.44）。解释尽管中国其他地区取得了进展，但新疆的肺结核患病率仍然很高。极低的PDR表明难以获得诊断和护理。需要进一步的研究来了解这一人群的诊断和护理障碍，迫切需要努力加强这一领域的结核病筛查。
Background Progress in tuberculosis control in China has been the slowest in western areas, which have the highest prevalence. We assessed the prevalence of pulmonary tuberculosis in the Xinjiang province, China, 10 years after introduction of a control programme based on directly observed treatment, short course.Methods In this population-based, cross-sectional survey, we used a multistage stratified random cluster sample design to estimate the prevalence of smear-positive and bacteriologically confirmed (either smear positive or culture positive, or both) pulmonary tuberculosis among adults (aged >= 15 years) in Xinjiang who had been resident in their household for the last 6 months. The screening strategy and diagnosis followed WHO guidelines. We estimated prevalence by combining inverse probability weighting and multiple imputation of missing data. We compared our prevalence survey estimates with the ones from the 2010 China national pulmonary tuberculosis survey and the ones from a provincial pulmonary survey done in Xinjiang in 2000. The new smear-positive pulmonary tuberculosis notification rate in 2011 in Xinjiang was obtained to allow the calculation of patient diagnosis rate (PDR).Findings Between Sept 1, 2010, and July 31, 2011, 31 081 individuals were eligible, of whom 29 835 (96.0%) participated in the survey. We identified 50 (0.2%) smear-positive and 101 (0.3%) bacteriologically confirmed pulmonary tuberculosis cases. The weighted prevalence of smear-positive pulmonary tuberculosis was 170 (95% CI 103-233) per 100 000 people and of bacteriologically confirmed pulmonary tuberculosis was 430 (249-611) per 100 000 people. Compared with 2000 Xinjiang survey estimates, the prevalence of smear-positive pulmonary tuberculosis has decreased by 26.4% (from 231 [95% CI 148-314] per 100 000 people), whereas the prevalence of bacteriologically confirmed pulmonary tuberculosis has increased by 17.8% (from 365 [237-493] per 100 000 people). In each age group and sex, the pulmonary tuberculosis prevalence was higher in the 2010-11 Xinjiang survey than in the 2010 national survey. The PDR in 2011 was 0.34 (95% CI 0.25-0.44).Interpretation Despite progress in other parts of China, the prevalence of pulmonary tuberculosis in Xinjiang remains high. The very low PDR suggests poor access to diagnosis and care. Further studies are needed to understand the barriers to diagnosis and care of this population, and efforts are urgently needed to enhance tuberculosis screening in this area.