Incidence and prevalence of tuberculosis in incarcerated populations: a systematic review and meta-analysis.
Incidence and prevalence of tuberculosis in incarcerated populations: a systematic review and meta-analysis.
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DOI：
10.1016/s2468-2667(21)00025-6
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Andrews JR
中科院分区：
文献类型：
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作者：
Cords O;Martinez L;Warren JL;O'Marr JM;Walter KS;Cohen T;Zheng J;Ko AI;Croda J;Andrews JR
监狱被认为是结核病的高风险环境，但对全球和区域结核病发病率和流行程度及其在监狱中的决定因素的系统调查很少。我们进行了系统回顾和荟萃分析，按地理区域评估被监禁人群中结核病的发病率和流行程度。在这项系统评价和荟萃分析中，我们检索了MEDLINE、Embase、Web of Knowledge和LILACS电子数据库，从1980年1月1日至2020年11月15日，以获取报告所有地理区域被监禁人员中结核分枝杆菌感染发生率、结核病发病率或结核病患病率的横断和队列研究。我们从个别研究中提取数据，并通过分层贝叶斯元回归模型计算发病率和患病率的汇总估计。我们还按地区进行了亚组分析。监狱与一般人口之间的发病率比率是通过将监狱中的结核病发病率除以世卫组织对全国人口发病率的估计来计算的。我们确定了159项相关研究；调查在押人员结核分枝杆菌感染发生率11例（16 318例），结核病发病率51例（1 858 323例），结核病患病率106例（6 727 513例）。在押人员结核分枝杆菌感染的总合并发病率为每100人年15.0（95%可信区间[CrI] 3.8 ~ 41.6）。在世卫组织非洲区域（2190 [95% CrI 810-4840]例）和东南亚区域（1550[240-5300]例）以及南美洲区域（970[460-1860]例）的研究中，囚犯的结核病发病率（每10万人年）最高，北美区域（30[20-50]例）和世卫组织东地中海区域（270[50-880]例）最低。除北美和西太平洋外，全球所有区域的结核病患病率均高于每10万名囚犯1000例，世卫组织东南亚区域最高（每10万名囚犯1810例[95% CrI 670-4000]）。南美洲监狱与一般人群的发病率比（26.9;95% CrI 17.1 - 40.1）远高于其他地区，但在世卫组织非洲地区（12.6;6.2 - 22.3）、东地中海地区（15.6;6.5 - 32.5）和东南亚地区（11.7;4.1 - 27.1）仍高于10%。在全球范围内，监狱中的人感染结核分枝杆菌并发展为结核病的风险很高，各区域监狱和一般人群之间始终存在差异。结核病控制规划应优先考虑对被监禁人群进行预防性干预。美国国立卫生研究院。
Prisons are recognised as high-risk environments for tuberculosis, but there has been little systematic investigation of the global and regional incidence and prevalence of tuberculosis, and its determinants, in prisons. We did a systematic review and meta-analysis to assess the incidence and prevalence of tuberculosis in incarcerated populations by geographical region. In this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Knowledge, and the LILACS electronic database from Jan 1, 1980, to Nov 15, 2020, for cross-sectional and cohort studies reporting the incidence of Mycobacterium tuberculosis infection, incidence of tuberculosis, or prevalence of tuberculosis among incarcerated individuals in all geographical regions. We extracted data from individual studies, and calculated pooled estimates of incidence and prevalence through hierarchical Bayesian meta-regression modelling. We also did subgroup analyses by region. Incidence rate ratios between prisons and the general population were calculated by dividing the incidence of tuberculosis in prisons by WHO estimates of the national population-level incidence. We identified 159 relevant studies; 11 investigated the incidence of M tuberculosis infection (n=16 318), 51 investigated the incidence of tuberculosis (n=1 858 323), and 106 investigated the prevalence of tuberculosis (n=6 727 513) in incarcerated populations. The overall pooled incidence of M tuberculosis infection among prisoners was 15·0 (95% credible interval [CrI] 3·8–41·6) per 100 person-years. The incidence of tuberculosis (per 100 000 person-years) among prisoners was highest in studies from the WHO African (2190 [95% CrI 810–4840] cases) and South-East Asia (1550 [240–5300] cases) regions and in South America (970 [460–1860] cases), and lowest in North America (30 [20–50] cases) and the WHO Eastern Mediterranean region (270 [50–880] cases). The prevalence of tuberculosis was greater than 1000 per 100 000 prisoners in all global regions except for North America and the Western Pacific, and highest in the WHO South-East Asia region (1810 [95% CrI 670–4000] cases per 100 000 prisoners). The incidence rate ratio between prisons and the general population was much higher in South America (26·9; 95% CrI 17·1–40·1) than in other regions, but was nevertheless higher than ten in the WHO African (12·6; 6·2–22·3), Eastern Mediterranean (15·6; 6·5–32·5), and South-East Asia (11·7; 4·1–27·1) regions. Globally, people in prison are at high risk of contracting M tuberculosis infection and developing tuberculosis, with consistent disparities between prisons and the general population across regions. Tuberculosis control programmes should prioritise preventive interventions among incarcerated populations. US National Institutes of Health.