Global burden of tuberculosis - Estimated incidence, prevalence, and mortality by country
Global burden of tuberculosis - Estimated incidence, prevalence, and mortality by country
复制标题
DOI：
10.1001/jama.282.7.677
复制
发表时间：
1999-08-18
影响因子：
120.7
通讯作者：
Raviglione, RC
中科院分区：
文献类型：
--
作者：
Dye, C;Scheele, S;Raviglione, RC
目的评估1997年212个国家结核分枝杆菌（Mycobacterium tuberculosis，MTB）感染的危险性和患病率，以及结核病（TB）的发病率、患病率和死亡率，包括人类免疫缺陷病毒（HIV）引起的疾病。证据每个国家的结核病发病率和死亡率是通过（1）向世卫组织通报的病例，（2）结核菌素调查的年度感染风险数据，和（3）流行率调查的涂片阳性肺病流行率数据确定的，从相对较差的数据中得出的估计数受到小组成员意见的强烈影响。客观估计值来自于最近通过批准的程序收集的高质量数据，以下各方达成共识：（1）与会者审查方法和数据，并在世卫组织6个区域办事处举行的剂量研讨会上作出临时估计，（2）主要作者使用标准方法和所有可用数据改进估计值，（3）国家专家审查和调整这些估计数，并与世卫组织工作人员达成最后协议。结论1997年，结核病新病例总数估计为796万例（范围，630万-1110万），包括352万（280万-490万）例（44%）传染性肺病（涂片阳性），现有病例1620万（1210万-2250万）例。估计有187万人（140万至280万）死于结核病，全球病死率为23%，但在一些艾滋病毒感染率高的非洲国家超过50%，全球结核病感染率为32%（18.6亿人）。在22个国家发现了80%的结核病病例，其中一半以上的病例发生在5个东南亚国家，人均发病率最高的10个国家中有9个在非洲。全球MTB/HIV合并感染的患病率为0.18%，64万例新发结核病例（8%）有HIV感染。结核病的全球负担仍然巨大，主要是因为东南亚、撒哈拉以南非洲和东欧的控制不力，以及一些非洲国家结核分枝杆菌和艾滋病毒合并感染的高发病率。
Objective To estimate the risk and prevalence of Mycobacterium tuberculosis (MTB) infection and tuberculosis (TB) incidence, prevalence, and mortality, including disease attributable to human immunodeficiency virus (HIV), for 212 countries in 1997.Participants A panel of 86 TB experts and epidemiologists from more than 40 countries was chosen by the World Health Organization (WHO), with final agreement being reached between country experts and WHO staff.Evidence Incidence of TB and mortality in each country was determined by (1) case notification to the WHO, (2) annual risk of infection data from tuberculin surveys, and (3) data on prevalence of smear-positive pulmonary disease from prevalence surveys, Estimates derived from relatively poor data were strongly influenced by panel member opinion. Objective estimates were derived from high-quality data collected recently by approved procedures,Consensus Process Agreement was reached by (1) participants reviewing methods and data and making provisional estimates in dosed workshops held at WHO's 6 regional offices, (2) principal authors refining estimates using standard methods and all available data, and (3) country experts reviewing and adjusting these estimates and reaching final agreement with WHO staff.Conclusions In 1997, new cases of TB totaled an estimated 7.96 million (range, 6.3 million-11.1 million), including 3.52 million (2.8 million-4.9 million) cases (44%) of infectious pulmonary disease (smear-positive), and there were 16.2 million (12.1 million-22.5 million) existing cases of disease. An estimated 1.87 million (1.4 million-2.8 million) people died of TB and the global case fatality rate was 23% but exceeded 50% in some African countries with high HIV rates, Global prevalence of MTB infection was 32% (1.86 billion people). Eighty percent of all incident TB cases were found in 22 countries, with more than half the cases occurring in 5 Southeast Asian countries, Nine of 10 countries with the highest incidence rates per capita were in Africa. Prevalence of MTB/HIV coinfection worldwide was 0.18% and 640 000 incident TB cases (8%) had HIV infection. The global burden of tuberculosis remains enormous, mainly because of poor control in Southeast Asia, sub-Saharan Africa, and eastern Europe, and because of high rates of M tuberculosis and HIV coinfection in some African countries.