Epidemiological characteristics of pulmonary tuberculosis among students in Wuhan from 2011 to 2020
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摘要:
目的 分析2011—2020年武汉市学生肺结核流行特征，为科学制定干预策略和措施提供依据。 方法 对国家结核病管理信息系统登记的2011—2020年武汉市学生结核病病案信息数据进行分布特征、发病就诊时间、治疗转归情况的统计分析。 结果 2011—2020年武汉市登记学生肺结核患者4 337例，年均登记发病率为22.44/10万，年均递降率为7.86%；男女发病数比为1.76∶1，男生发病率高于女生(χ2=184.18，P < 0.01)；发病年龄以19~22岁组最高，占47.89%；每年报告发病高峰是3—5月和9—11月，发病低谷是每年1—2月和7—8月；学生患者主要集中在学校分布较多的洪山区、江夏区和武昌区，学校聚集性疫情频发于洪山区、东西湖区、武昌区和新洲区；学生患者发病至就诊求医时间M(P25，P75)为9(3，21)d，按地区、年龄、民族和患者来源分组组间差异均有统计学意义(Z值分别为-9.25，47.14，9.88，43.96，P值均 < 0.01)；学生患者治疗与转归按年份、民族分组组间差异均有统计学意义(P值均 < 0.05)。 结论 武汉市学生肺结核疫情呈缓慢波动下降趋势，年龄段以大学生和高中生为主，集中发现时间和地点相对固定，病例就诊时间和治疗转归各有区别。应根据各区县学生分布特点因时因地分类地制定防控策略，加强疫情监测、健康促进、主动发现和督导管理。 Abstract:Objective To analyze the epidemiological characteristics of pulmonary tuberculosis among students in Wuhan from 2011 to 2020, and to provide a basis for the scientific development of interventions and strategies. Methods Epidemiological distribution, time of onset and treatment, as well as treatment outcomes of student tuberculosis in Wuhan from 2011 to 2020 registered in the national tuberculosis information management system were described. Results During 2011-2020, 4 337 student tuberculosis patients in Wuhan were registered. The average annual incidence rate was 22.44/10 million, and the annual decreasing rate of 7.86%. The incidence of male and female patients was 1.76:1, and the incidence rate of male was higher than that of female(χ2=184.18, P < 0.01). Most of patients aged 19-22 years old, accounting for 47.89%; Tuberculosis reports were highest during March to May, and September to November, and lowest during January to February, and July to August. Student patients were mainly concentrated in Hongshan District, Jiangxia District and Wuchang District, where schools were more distributed in Hongshan District, Dongxihu District, Wuchang District and Xinzhou District. The median duration from tuberculosis onset to treatment was 9(3, 21) days, which varied significantly by region, age, nationality, and patient residence (Z=-9.25, 47.14, 9.88, 43.96, P < 0.01). The treatment and outcome of student tuberculosis patients were varied significantly by year and nationality(P < 0.05). Conclusion The incidence of student tuberculosis in Wuhan City showed a slow downward trend. Most of student tuberculosis are college and high school students. Time and place of case detection are relatively fixed. The time of treatment and the outcome of treatment vary significantly. Tuberculosis prevention and control strategies should be formulated according to the local conditions according to the tuberculosis distribution characteristics, as well as enhancing surveillance, health promotion, active discovery and supervision management of tuberculosis in school settings. -
Key words:
- Tuberculosis, pulmonary /
- Epidemiologic studies /
- Incidence /
- Students
1) 利益冲突声明 所有作者声明无利益冲突。2) 张正斌与胡晶为并列第一作者。 -
表 1 武汉市2011—2020年学生肺结核登记发病情况
Table 1. Registered incidence of pulmonary tuberculosis among students in Wuhan from 2011 to 2020
年份 学生常住人口数/万 活动性肺结核报告数 病原学阳性报告数 2011 191.834 597(31.12) 166(8.65) 2012 184.747 588(31.83) 109(5.90) 2013 185.423 506(27.29) 102(5.50) 2014 182.832 478(26.14) 100(5.47) 2015 186.301 375(20.13) 78(4.19) 2016 186.650 462(24.75) 87(4.66) 2017 191.321 397(20.75) 81(4.23) 2018 197.860 314(15.87) 141(7.13) 2019 207.389 320(15.43) 148(7.14) 2020 218.692 300(13.72) 173(7.91) 合计 1 933.049 4 337(22.44) 1 185(6.13) 注： ()内数字为报告发病率/10-5。 
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表 2 武汉市2011—2020年不同组别学生肺结核患者就诊延迟时间比较[M(P25, P75)]
Table 2. Comparison of the delay time of seeking medical treatment for different groups of students with pulmonary tuberculosis in Wuhan from 2011 to 2020[M(P25, P75)]
组别 患者数 就诊延迟/d H/Z值 P值 组别 患者数 就诊延迟/d H/Z值 P值 年份 民族 2011—2015 2 544 9(3, 21) 4.02 0.13 汉族 4 267 9(3, 21) 9.88 0.01 2016—2018 1 171 10(3, 20) 少数民族 54 15(8, 24) 2019—2020 622 10(4, 19) 外籍 16 10(2, 20) 地区 患者来源 近城区 3 287 8(3, 18) -9.25 < 0.01 健康检查 17 4(3, 18) 43.96 < 0.01 远城区 1 050 14(4, 32) 接触者检查 17 14(4, 23) 性别 因症就诊 269 7(4, 15) 男 2 765 9(3, 20) -0.87 0.38 转诊 3 237 9(3, 19) 女 1 572 9(3, 21) 追踪 797 13(4, 35) 年龄/岁 治疗分类 ≤12 99 13(7, 31) 47.14 < 0.01 初治 4 323 9(3, 21) -0.12 0.90 13~18 1 551 8(3, 19) 复治 14 6(2, 49) 19~22 2 077 9(3, 21) 患者分类 ≥23 610 12(5, 24) 病原学阳性 1 185 9(3, 25) -1.49 0.14 病原学阴性 3 152 9(3, 20)
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表 3 武汉市2011—2020年学生肺结核患者治疗与转归情况
Table 3. Treatments and outcomes of student pulmonary tuberculosis in Wuhan from 2011 to 2020
变量 选项 病原学阳性 病原学阴性 治疗成功情况 患者数 治愈人数 患者数 完成治疗人数 患者数 治疗成功人数 χ2值 P值 年份 2011—2015 555 530(95.50) 1 989 1 969(98.99) 2 544 2 499(98.23) 75.77 < 0.01 2016—2018 307 291(94.79) 864 835(96.64) 1 171 1 126(96.16) 2019—2020 323 275(85.14) 299 293(97.99) 622 568(91.32) 地区 近城区 906 838(92.49) 2 381 2 339(98.24) 3 287 3 177(96.65) 0.03 0.86 远城区 279 258(92.47) 771 758(98.31) 1 050 1 016(96.76) 性别 男 681 632(92.80) 2 084 2 045(98.13) 2 765 2 677(96.82) 0.45 0.50 女 504 464(92.06) 1 068 1 052(98.50) 1 572 1 516(96.44) 年龄/岁 ≤12 28 28(100.00) 71 69(97.18) 99 97(97.98) 4.66a 0.20 13~18 473 429(90.70) 1 078 1 063(98.61) 1 551 1 492(96.20) 19~22 551 514(93.28) 1 526 1 505(98.62) 2 077 2 019(97.21) ≥23 133 125(93.98) 477 460(96.44) 610 585(95.90) 民族 汉族 1 171 1 084(92.57) 3 096 3 044(98.32) 4 267 4 128(96.74) 0.02b 少数民族 11 10(90.91) 43 42(97.67) 54 52(96.30) 外籍 3 2(66.67) 13 11(84.62) 16 13(81.25) 治疗分类 初治 1 171 1 085(92.66) 3 152 3 097(98.26) 4 323 4 182(96.74) 0.00a 0.92 复治 14 11(78.57) 0 0 14 11(78.51) 注： ()内数字为百分率/%；a为校正χ2值，b为Fisher确切概率法。
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