嘉兴市2011—2020年学校肺结核流行特征及就诊延迟状况

王远航; 朱国英; 葛锐; 茅蓉; 陈中文

doi:10.16835/j.cnki.1000-9817.2022.10.028

嘉兴市2011—2020年学校肺结核流行特征及就诊延迟状况

doi: 10.16835/j.cnki.1000-9817.2022.10.028

浙江省嘉兴市疾病预防控制中心传染病预防控制科，314050

基金项目:

嘉兴市科技计划项目 2022AY30026

详细信息

作者简介:
王远航(1990-)，女，黑龙江齐齐哈尔人，硕士，主治医师，主要从事传染病预防控制工作

通讯作者:
陈中文，E-mail：czw@jxcdc.gov.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R181.3 R521 R183
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- 被引次数: 0
出版历程
- 收稿日期: 2022-05-12
- 修回日期: 2022-07-07
- 网络出版日期: 2022-10-28
- 刊出日期: 2022-10-25

Epidemiology and associated factors of delay for tuberculosis treatment among schools in Jiaxing during 2011-2020

Department of Infectious Disease Control and Prevention, Jiaxing Center for Disease Control and Prevention, Jiaxing(314050), Zhejiang Province, China

摘要

摘要: 目的分析嘉兴市学校肺结核流行趋势及特征，为推动学校结核病防控工作提供依据。方法从“结核病信息管理系统”中导出2011—2020年嘉兴市学校肺结核病案信息，利用描述流行病学方法对监测数据进行分析。结果 2011—2020年嘉兴市累计报告学生和教师肺结核病例分别为436和46例，教师肺结核年均报告发病率(10.70/10万)高于学生(6.16/10万)(χ²=13.06，P＜0.05)；学校肺结核年均报告发病率(6.59/10万)低于全人群报告发病率(37.91/10万)(χ²=184.63，P＜0.05)；学校肺结核以3—5月发病居多，分别占比11.62%，11.00%，9.96%；2012年县级学校肺结核发病率较市级低，2017和2020年较市本级高(χ²值分别为4.61，5.72，4.02，P值均＜0.05)；15~19岁学生肺结核病例最多，男生肺结核病例数(90名)占比高于女生(75名)；小学教师和初中教师比同学段院校学生肺结核报告发病率高(χ²值分别为24.34，14.87，P值均＜0.05)；发现方式以因症就诊、转诊等被动发现为主，就诊延迟率为34.23%。结论早期发现传染源、及时的科学处置、缩短就诊延迟时间是防止疫情传播扩散的关键，对减少聚集性疫情和突发公共卫生事件的发生意义重大。
- 结核，肺 /
- 流行病学研究 /
- 发病率 /
- 回归分析
Abstract: Objective To understand epidemiology and associated factors of delay for tuberculosis in schools of Jiaxing, and to provide basis for the strategy of pulmonary tuberculosis prevention and control in schools. Methods Based on the Tuberculosis Management Information System, the information of school tuberculosis cases in Jiaxing from 2011 to 2020 was collected, and the epidemiological characteristics were analyzed by descriptive epidemiology. Results A total of 436 student pulmonary tuberculosis patients and 46 teacher pulmonary tuberculosis patients were reported in Jiaxing from 2011 to 2020. The average annual incidence rate in teachers (10.70/100 000) was higher than that in students (6.16/100 000) (χ²=13.06, P < 0.05). The incidence rate of school pulmonary tuberculosis (6.59/100 000) was lower than that in the whole population (37.91/100 000) (χ²=184.63, P < 0.05). The school pulmonary tuberculosis patients mainly occurred from March to May, accounted for 11.62%, 11.00%, 9.96% respectively. The incidence rate of school pulmonary tuberculosis patients in county level was lower than in urban district in 2012, and higher than in urban district in 2017 and 2020(χ²=4.61, 5.72, 4.02, P < 0.05). Most student pulmonary tuberculosis patients aged from 15 to 19 years old, the percentage was higher in males(90) than in females(75) in students. The reported incidence rate of pulmonary tuberculosis in primary school and junior high school teachers was higher than that in the same students (χ²=24.34, 14.87, P < 0.05). Passive case-finding including clinical symptomatic inspection and referrals was the main way to find cases. The detection delay rate was 34.23%. Conclusion Early detection, prompt and scientific treatment, shortening the delay time were key to prevent the spread of the school tuberculosis. It is of great significance to reduce the occurrence of clustering in outbreak and public health emergency.
- Tuberculosis, pulmonary /
- Epidemiologic studies /
- Incidence /
- Regression analysis
注释:

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图 1 嘉兴市2011—2020年学校肺结核流行趋势

Figure 1. Prevalence trend of school pulmonary tuberculosis in Jiaxing, 2011-2020

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表 1 嘉兴市2011—2020年学校肺结核发病情况

Table 1. Incidence of school pulmonary tuberculosis in Jiaxing City, 2011-2020

年份	人口数/万	发病数/例	病原学阳性发病数/例
2011	70.68	50(7.07)	18(2.55)
2012	70.82	57(8.05)	19(2.68)
2013	69.17	43(6.22)	21(3.04)
2014	72.79	56(7.69)	21(2.89)
2015	70.42	37(5.25)	14(1.99)
2016	71.10	54(7.59)	23(3.23)
2017	73.17	34(4.65)	12(1.64)
2018	75.15	48(6.39)	19(2.53)
2019	78.19	59(7.55)	28(3.58)
2020	81.51	44(5.40)	25(3.07)
注：()内数字为发病率/10^-5。

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表 2 嘉兴市2011—2020年学校肺结核发病率地区间比较

Table 2. Comparison of different regional incidence rates among school pulmonary tuberculosis in Jiaxing City, 2011-2020

年份	市区		县		χ²值	P值
年份	人口数/万	发病数/例	人口数/万	发病数/例	χ²值	P值
2011	23.59	13(5.51)	47.09	37(7.86)	1.22	0.27
2012	24.01	27(11.25)	46.81	30(6.41)	4.61	0.03
2013	23.49	19(8.09)	45.68	24(5.25)	2.01	0.16
2014	27.79	28(10.08)	45.00	28(6.22)	3.32	0.07
2015	25.93	13(5.01)	44.49	24(5.39)	0.05	0.83
2016	26.99	22(8.15)	44.11	32(7.25)	0.18	0.67
2017	27.44	6(2.19)	45.73	28(6.12)	5.72	0.02
2018	27.33	11(4.02)	47.81	37(7.70)	3.76	0.05
2019	29.00	22(7.59)	49.19	37(7.52)	0.00	0.98
2020	30.44	10(3.29)	51.08	34(6.66)	4.02	< 0.05
注：()内数字为发病率/10^-5；市区为南湖区、秀洲区，县为海宁市、平湖市、桐乡市、嘉善县、海盐县。

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表 3 嘉兴市学校肺结核病例就诊延迟单因素分析

Table 3. Univariate analysis of patient delay among school pulmonary tuberculosis in Jiaxing City

变量	选项	人数	就诊延迟人数	χ²值	P值
性别	男	274	90(32.85)	0.54	0.46
	女	208	75(36.06)
职业	教师	46	14(30.43)	0.33	0.57
	学生	436	151(34.63)
时间	第一季度	128	50(39.06)	3.69	0.30
	第二季度	129	37(28.68)
	第三季度	126	41(32.54)
	第四季度	99	37(37.37)
学段	幼儿园	5	2(40.00)	1.23	0.87
	小学	42	12(28.57)
	初中	71	23(32.39)
	高中	192	65(33.85)
	大专及以上	172	63(36.63)
发现方式	被动就诊	472	165(34.96)		0.02^*
	主动就诊	10	0
诊断结果	病原学阳性	232	97(41.81)	11.53	< 0.01
	病原学阴性	234	63(26.92)
	结核性胸膜炎	16	5(31.25)
治疗分类	初治	479	164(34.24)	< 0.01	1.00^#
	复治	3	1(33.33)
注：()内数字为就诊延迟率/%；主动就诊包括健康体检、主动筛查；被动就诊包括因症就诊、转诊、追踪、推介；*Fisher确切概率法，#连续校正χ²检验。

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