内蒙古自治区2011—2022年学生肺结核发现和诊疗延迟情况及影响因素

徐丽娟; 贾莅莉; 王文瑞

doi:10.16835/j.cnki.1000-9817.2023.11.029

内蒙古自治区2011—2022年学生肺结核发现和诊疗延迟情况及影响因素

doi: 10.16835/j.cnki.1000-9817.2023.11.029

徐丽娟¹,
贾莅莉^2, ,,
王文瑞^3, ,

1.
内蒙古自治区综合疾病预防控制中心结核病防治科, 呼和浩特 010031
2.
内蒙古自治区第四医院危重症医学科
3.
内蒙古自治区综合疾病预防控制中心

基金项目:

内蒙古自治区卫生健康委2022年度医疗卫生科技计划项目 202202113

详细信息

作者简介:
徐丽娟(1982-), 女, 内蒙古赤峰人, 硕士, 副主任医师, 主要从事结核病预防与控制方面工作

通讯作者:
贾莅莉, E-mail: lily4455.love@163.com

王文瑞, E-mail: 147035297@qq.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: G478 R521 R181.3⁺²
计量
- 文章访问数: 312
- HTML全文浏览量: 183
- PDF下载量: 36
- 被引次数: 0
出版历程
- 收稿日期: 2023-06-09
- 修回日期: 2023-08-04
- 网络出版日期: 2023-11-27
- 刊出日期: 2023-11-25

Delay on detection, and diagnosis of pulmonary tuberculosis and the influencing factors in Inner Mongolia students during 2011-2022

XU Lijuan¹,
JIA Lili^{2
, ,},
WANG Wenrui^{3
, ,}

1.
Tuberculosis Prevention and Control Department, Inner Mongolia Autonomous Region Comprehensive Center for Disease Control and Prevention, Hohhot (010031), Inner Mongolia Autonomous Region, China

摘要

摘要: 目的了解2011-2022年内蒙古自治区学生肺结核发现、就诊、确诊、治疗四类延迟情况及影响因素, 为学生结核防治提供依据。方法从中国疾病预防控制信息系统的传染病监测(新)模块收集2011年1月1日至2022年12月31日内蒙古学生肺结核患者基本资料, 分析四类延迟基本情况和变化趋势, 采用多因素Logistic回归分析四类延迟的影响因素。结果 2011-2022年内蒙古共登记学生肺结核患者6 032例, 发现、就诊、确诊、治疗延迟率分别为51.71%, 64.01%, 7.82%, 2.30%。多因素Logistic回归分析结果显示, 患者来源中的追踪(OR=1.51)及诊断机构级别为盟市级(OR=3.16)、旗县级(OR=2.41)与发现延迟呈正相关; 诊断机构级别为盟市级(OR=2.69)、旗县级(OR=3.67)与就诊延迟呈正相关; 患者来源于转诊(OR=1.58)和追踪(OR=2.55)、户籍为流动人口(OR=2.05)、治疗分类为复治(OR=2.11)及影像学表现中无结果(OR=2.19)与确诊延迟呈正相关; 患者来源为转诊(OR=1.84)、追踪(OR=4.91)和主动筛查(OR=5.46)及流动人口(OR=1.95)与治疗延迟呈正相关(P值均 < 0.05)。结论内蒙古2011-2022年学生肺结核患者发现、就诊延迟处于较高水平, 确诊和治疗延迟处于相对较低水平。应针对四类延迟的主要影响因素, 制定针对性的防控措施, 降低学校疫情发生风险。
- 结核, 肺 /
- 诊断 /
- 时间 /
- 回归分析 /
- 学生 /
- 少数民族
Abstract: Objective To analyze the delay on detection, care-seeking, diagnosis and treatment of tuberculosis among students in Inner Mongolia Autonomous Region (Inner Mongolia) from 2011 to 2022 and its influencing factors, so as to provide support for the prevention and treatment of tuberculosis among students. Methods The general demographic indicators of students with tuberculosis in Inner Mongolia from January 1, 2011 to December 31, 2022 were collected from the infectious disease monitoring (new) module of the China Disease Prevention and Control Information System.General characteristics and trend of four types of delayed pulmonary tuberculosis patients in students were analyzed.The influencing factors were analyzed using univariate and multivariate Logistic regressions. Results From 2011 to 2022, there were 6 032 cases of pulmonary tuberculosis among students in Inner Mongolia.The rates of delayed detection, delayed care-seeking, delayed diagnosis, and delayed treatment were 51.71%, 64.01%, 7.82%, and 2.30%, respectively.The results of multivariate Logistic regression analysis showed that tracking (OR=1.51) in the patient source, league-level diagnosis (OR=3.16) in the diagnostic institution level, and county-level diagnosis (OR=2.41) were positively associated with delayed discovery (P < 0.05).At the level of diagnostic unit, league city-level diagnosis (OR=2.69), and county-level diagnosis (OR=3.67) associated with more delayed care-seeking (P < 0.05).Referral (OR=1.58) and follow-up (OR=2.55), floating population (OR=2.05), further consultation with a doctor (OR=2.11), and no results in imaging manifestations (OR=2.19) were positively associated with delayed diagnosis (P < 0.05).The factors contributing to delayed treatment were referral (OR=1.84), follow-up (OR=4.91), active screening (OR=5.46), and floating population (OR=1.95)(P < 0.05). Conclusions From 2011 to 2022, the delay on detection and care-seeking for tuberculosis patients among students in Inner Mongolia is at a relatively high level, while the delay in diagnosis and treatment is at a relatively low level but shows an increasing trend.It is necessary to focus on the factors associated with delays in identification, diagnosis and treatment in tuberculosis outbreak in the context of school to prevent or reduce school tuberculosis outbreak.
- Tuberculosis, pulmonary /
- Diagnosis /
- Time /
- Regression analysis /
- Students /
- Minority groups
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

表 1 内蒙古学生2011—2022年肺结核四类延迟率比较

Table 1. Comparison of the four delay rates of tuberculosis among Inner Mongolia students from 2011 to 2022

年份	患者人数	发现延迟	就诊延迟	确诊延迟	治疗延迟
2011	969	546(56.35)	664(68.52)	69(7.12)	11(1.14)
2012	685	382(55.77)	476(69.49)	55(8.03)	4(0.58)
2013	845	439(51.95)	586(69.35)	37(4.38)	8(0.95)
2014	513	268(52.24)	340(66.28)	37(7.21)	9(1.75)
2015	429	230(53.61)	279(65.03)	34(7.93)	12(2.80)
2016	326	164(50.31)	207(63.50)	22(6.75)	9(2.76)
2017	396	207(52.27)	253(63.89)	33(8.33)	8(2.02)
2018	511	255(49.90)	299(58.51)	40(7.83)	6(1.17)
2019	468	218(46.58)	267(57.05)	38(8.12)	39(8.33)
2020	392	165(42.09)	217(55.36)	29(7.40)	7(1.79)
2021	291	151(51.89)	158(54.30)	48(16.49)	12(4.12)
2022	207	94(45.41)	115(55.56)	30(14.49)	14(6.76)
χ²值		37.28	76.96	58.80	124.89
P值		< 0.01	< 0.01	< 0.01	< 0.01
注： ()内数字为延迟率/%。

下载: 导出CSV

表 2 内蒙古2011—2022年学生肺结核患者四类延迟单因素分析

Table 2. Univariate analysis on the four types of delay of pulmonary tuberculosis among students in Inner Mongolia, 2011-2022

影响因素	选项	人数	发现			就诊			确诊			治疗
影响因素	选项	人数	延迟人数	χ²值	P值	延迟人数	χ²值	P值	延迟人数	χ²值	P值	延迟人数	χ²值	P值
性别	男	3 238	1 637(50.56)	3.71	0.05	2 051(63.34)	1.35	0.25	263(8.12)	0.86	0.36	78(2.41)	0.34	0.56
	女	2 794	1 482(53.04)			1 810(64.78)			209(7.48)			61(2.18)
民族	汉族	3 560	1 894(53.20)	7.77	0.02	2 265(63.62)	1.26	0.53	311(8.74)	10.04	< 0.01	93(2.61)	4.57	0.10
	蒙古族	2 329	1 154(49.55)			1 499(64.36)			151(6.48)			45(1.93)
	其他	143	71(49.65)			97(67.83)			10(6.99)			1(0.70)
季度	一	1 499	796(53.10)	14.51	< 0.01	967(64.51)	1.74	0.63	129(8.61)	3.00	0.40	31(2.07)	2.54	0.47
	二	1 823	935(51.29)			1 161(63.69)			128(7.02)			38(2.08)
	三	1 371	749(54.63)			892(65.06)			108(7.88)			39(2.84)
	四	1 339	639(47.72)			841(62.81)			107(7.99)			31(2.32)
学段	小学及幼儿园	248	127(51.21)	8.72	0.03	157(63.31)	11.87	< 0.01	14(5.65)	8.53	0.04	5(2.02)	4.87	0.18
	初中	723	349(48.27)			471(65.15)			55(7.61)			17(2.35)
	高中	2 319	1 115(48.08)			1 424(61.41)			160(6.90)			42(1.81)
	大学及以上	2 742	1 227(44.75)			1 809(65.97)			243(8.86)			75(2.74)
患者来源	直接就诊	2 105	1 126(53.49)	189.01	< 0.01	1 452(68.98)	131.23	< 0.01	103(4.89)	126.67	< 0.01	21(1.00)	95.61	< 0.01
	转诊	1 838	867(47.17)			1 075(58.49)			142(7.73)			35(1.90)
	追踪	1 370	861(62.85)			947(69.12)			199(14.53)			76(5.55)
	推介	218	115(52.75)			145(66.51)			9(4.13)			2(0.92)
	健康体检	319	94(29.47)			156(48.90)			11(3.45)			0
	其他	102	22(21.57)			36(35.29)			6(5.88)			5(4.90)
	主动筛查	80	34(42.50)			50(62.50)			2(2.50)			0
户籍	本地	4 971	2 567(51.64)	0.05	0.82	3 245(65.28)	19.79	< 0.01	337(6.78)	42.84	< 0.01	91(1.83)	28.18	< 0.01
	流动	1 061	552(52.03)			616(58.06)			135(12.72)			48(4.52)
诊断机构级别	自治区级	95	26(27.37)	190.77	< 0.01	34(35.79)	33.66	< 0.01	12(12.63)	3.11	0.21	5(5.26)	4.59	0.10
	盟市级	531	419(78.91)			348(65.54)			42(7.91)			15(2.82)
	旗县级	5 406	2 674(49.46)			3 479(64.35)			418(7.73)			119(2.20)
诊断类型	病原学阳性	1 541	912(59.18)	47.14	< 0.01	1 083(70.28)	56.12	< 0.01	133(8.63)	4.71	0.19	45(2.92)	6.88	0.08
	病原学阴性	3 628	1 776(48.95)			2 188(60.31)			270(7.44)			69(1.90)
	结核性胸膜炎	814	404(49.63)			560(68.80)			68(8.35)			23(2.83)
	无病原学结果	49	27(55.10)			30(61.22)			1(2.04)			2(4.08)
治疗分类	初治	5 943	3 066(51.59)	2.23	0.14	3 800(63.94)	0.81	0.37	460(7.74)	4.01	0.05	135(2.27)	1.92	0.17
	复治	89	53(59.55)			61(68.54)			12(13.48)			4(4.49)
影像学表现	异常	5 836	3 018(51.71)	3.14	0.21	3 748(64.22)	5.41	0.07	442(7.57)	19.39	< 0.01	128(2.19)	10.02	< 0.01
	无异常	30	11(36.67)			14(46.67)			2(6.67)			2(6.67)
	无结果	166	90(54.22)			99(59.64)			28(16.87)			9(5.42)
注：其他民族包括满族、达斡尔族、鄂温克族等；()内数字为延迟率/%。

下载: 导出CSV

表 3 内蒙古学生2011—2022年肺结核四类延迟多因素Logistic回归分析(n=6 032)

Table 3. Multivariate analysis on the four types of delay of pulmonary tuberculosis among students in Inner Mongolia, 2011-2022 (n=6 032)

自变量	选项	发现延迟		就诊延迟		确诊延迟		治疗延迟
自变量	选项	OR值(95%CI)	P值	OR值(95%CI)	P值	OR值(95%CI)	P值	OR值(95%CI)	P值
季度	二	0.97(0.84~1.12)	0.67
	三	1.07(0.92~1.24)	0.39
	四	0.84(0.72~0.98)	0.03
患者来源	转诊	0.77(0.68~0.88)	< 0.01	0.61(0.54~0.70)	< 0.01	1.58(1.20~2.10)	< 0.01	1.84(1.06~3.18)	0.03
	追踪	1.51(1.31~1.74)	< 0.01	0.98(0.84~1.15)	0.83	2.55(1.94~3.35)	< 0.01	4.91(2.98~8.10)	< 0.01
	推介	0.79(0.59~1.05)	0.10	0.84(0.63~1.14)	0.27	0.72(0.33~1.57)	0.40	0.90(0.21~3.86)	0.88
	健康体检	0.45(0.34~0.59)	< 0.01	0.44(0.35~0.56)	< 0.01	0.89(0.47~1.68)	0.72	0	0.99
	主动筛查	0.32(0.20~0.53)	< 0.01	0.25(0.17~0.39)	< 0.01	1.22(0.48~3.09)	0.67	5.46(2.00~14.89)	< 0.01
	其他	0.78(0.49~1.23)	0.28	0.78(0.49~1.24)	0.29	0.45(0.11~1.89)	0.28	0	1.00
户籍	流动			0.79(0.68~0.91)	< 0.01	2.05(1.64~2.57)	< 0.01	1.95(1.35~2.82)	< 0.01
诊断机构级别	盟市级	3.16(1.94~5.16)	< 0.01	2.69(1.68~4.30)	< 0.01
	旗县级	2.41(1.52~3.84)	< 0.01	3.67(2.33~5.77)	< 0.01
治疗分类	复治					2.11(1.09~4.09)	0.03
影像学表现	无异常					0.42(0.06~3.10)	0.39	2.63(0.60~11.60)	0.20
	无结果					2.19(1.39~3.43)	< 0.01	1.94(0.95~3.96)	0.07

下载: 导出CSV

参考文献(16)

[1]	钟球, 成诗明, 周林. 学校结核病筛查技术手册[M]. 北京: 人民卫生出版社, 2018: 3. ZHONG Q, CHENG S M, ZHOU L. School tuberculosis screening technical manual[M]. Beijing: People's Medical Publishing House, 2018: 3. (in Chinese)
[2]	陈伟, 赵雁林. 高度重视我国学校结核病防治工作[J]. 结核与肺部疾病杂志, 2021, 2(4): 301-304. https://www.cnki.com.cn/Article/CJFDTOTAL-FBJK202104001.htm CHEN W, ZHAO Y L. Attach great importance to the prevention and treatment of tuberculosis in schools in China[J]. J Tubercul Lung Dis, 2021, 2(4): 301-304(in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-FBJK202104001.htm
[3]	徐丽娟, 乌晓峰, 郎胜利, 等. 2015—2020年内蒙古自治区学生肺结核疫情变化趋势及特征分析[J]. 疾病监测, 2022, 37(3): 331-335. https://www.cnki.com.cn/Article/CJFDTOTAL-JBJC202203013.htm XU L J, WU X F, LANG S L, et al. Change trend and characteristics of tuberculosis epidemic among students in Inner Mongolia Autonomous Region from 2015 to 2020[J]. Dis Surveill, 2022, 37(3): 331-335. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-JBJC202203013.htm
[4]	中国疾病预防控制中心结核病预防控制中心. 中国结核病防治工作指南(2021年版)[M]. 北京: 人民卫生出版社, 2021: 16. Chinese Center for Disease Control and Prevention, Tuberculosis Prevention and Control Center. Guideline for Tuberculosis Prevention and Control in China (2021 edition)[M]. Beijing: People's Medical Publishing House, 2021: 16. (in Chinese)
[5]	胡洁, 顾伟玲, 王远航, 等. 2010—2019年浙江省嘉兴市学生肺结核患者发现延误及其影响因素分析[J]. 疾病监测, 2021, 36(10): 1021-1024. https://www.cnki.com.cn/Article/CJFDTOTAL-JBJC202110012.htm HU J, GU W L, WANG Y H, et al. Delayed detection of pulmonary tuberculosis among students in Jiaxing City, Zhejiang Province from 2010 to 2019 and its influencing factors[J]. Dis Surveill, 2021, 36(10): 1021-1024. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-JBJC202110012.htm
[6]	姜世闻. 采取综合措施提高肺结核患者病原学检出率[J]. 中国防痨杂志, 2019, 41(5): 477-479. doi: 10.3969/j.issn.1000-6621.2019.05.001 JIANG S W. Taking comprehensive measures to improve the etiology detection rate of pulmonary tuberculosis patients[J]. Chin J Tubercul, 2019, 41(5): 477-479. (in Chinese) doi: 10.3969/j.issn.1000-6621.2019.05.001
[7]	中华人民共和国卫生部疾病控制司, 中华人民共和国卫生部国外贷款办公室, 中国疾病预防控制中心, 等. 中国结核病控制项目社会评价研究报告(2004.3—2005.3)[R]. 北京: 中国协和医科大学出版社, 2006: 3-11, 291-349. Department of Disease Control Ministry of Health of the PRC, Foreign Loan Office of the PRC, Chinese Center for Disease Control and Prevention. Research report on social evaluation of tuberculosis control program in China (2004.3-2005.3)[R]. Beijing: China Union Medical College Press, 2006: 3-11, 291-349. (in Chinese)
[8]	张思源, 黄飞, 汪彦辉, 等. 家庭收入与新发涂阳肺结核诊治延迟的关系[J]. 南京医科大学学报(社会科学版), 2015, 15(1): 39-42. https://www.cnki.com.cn/Article/CJFDTOTAL-YKNS201501011.htm ZHANG S Y, HUANG F, WANG Y H, et al. The relationship between family income and delayed diagnosis and treatment of newly diagnosed smear-positive pulmonary tuberculosis[J]. J Nanjing Med Univ (Soc Sci Edit), 2015, 15(1): 39-42. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-YKNS201501011.htm
[9]	马丽, 梁智超, 陈阳贵, 等. 2010—2019年乌鲁木齐市学生结核病病例发现延迟、就诊延迟、确诊延迟分析[J]. 预防医学, 2023, 35(1): 53-56, 60. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYFX202301012.htm MA L, LIANG Z C, CHEN Y G, et al. Analysis of delayed detection, treatment and diagnosis of tuberculosis cases in Urumqi students from 2010 to 2019[J]. Prev Med, 2023, 35(1): 53-56, 60. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZYFX202301012.htm
[10]	白璐璐, 陈洪, 黄延, 等. 贵阳市2014—2020年学生肺结核患者发现就诊及确诊延迟影响因素分析[J]. 中国学校卫生, 2021, 42(12): 1776-1780, 1784. doi: 10.16835/j.cnki.1000-9817.2021.12.005 BAI L L, CHEN H, HUANG Y, et al. Analysis of factors influencing the delay of diagnosis and treatment of pulmonary tuberculosis in students in Guiyang from 2014 to 2020[J]. Chin J Sch Health, 2021, 42(12): 1776-1780, 1784. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2021.12.005
[11]	傅颖, 蒋骏, 张晓龙, 等. 苏州市2011—2020年学生肺结核患者发现延迟状况[J]. 中国学校卫生, 2021, 42(12): 1781-1784. doi: 10.16835/j.cnki.1000-9817.2021.12.006 FU Y, JIANG J, ZHANG X L, et al. Delayed detection of pulmonary tuberculosis among students in Suzhou from 2011 to 2020[J]. Chin J Sch Health, 2021, 42(12): 1781-1784. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2021.12.006
[12]	龚德华, 谭文倩, 黄娟, 等. 2011—2020年湖南省学生肺结核患者发现延误及其影响因素分析[J]. 中国防痨杂志, 2023, 45(3): 271-278. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202303009.htm GONG D H, TAN W Q, HUANG J, et al. Delayed detection of pulmonary tuberculosis among students in Hunan Province from 2011 to 2020 and its influencing factors[J]. Chin J Tubercul, 2019, 45(3): 271-278. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202303009.htm
[13]	马煜, 杜昕, 邓亚丽, 等. 陕西省2015—2019年学生肺结核患者就诊延迟影响因素分析[J]. 中国学校卫生, 2021, 42(4): 615-618, 622. doi: 10.16835/j.cnki.1000-9817.2021.04.031 MA Y, DU X, DENG Y L, et al. Analysis of influencing factors on delay in seeing a doctor in students with pulmonary tuberculosis from 2015 to 2019 in Shaanxi Province[J]. Chin J Sch Health, 2021, 42(4): 615-618, 622. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2021.04.031
[14]	王芸, 方世林, 禄晓龙, 等. 中国结核病患者三类延迟现况及其与经济因素关联的Meta分析[J]. 中国循证医学杂志, 2022, 22(7): 791-798. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXZ202207007.htm WANG Y, FANG S L, LU X L, et al. A Meta-analysis of three types of tuberculosis delay and its association with economic factors in Chinese patients[J]. Chin J Evide-Based Med, 2022, 22(7): 791-798. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXZ202207007.htm
[15]	国家感染性疾病临床医学研究中心, 深圳市第三人民医院, 《中国防痨杂志》编辑委员会. 肺结核活动性判断规范及临床应用专家共识[J]. 中国防痨杂志, 2020, 42(4): 301-307. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS202013078.htm National Clinical Medical Research Center of Infectious Diseases, the Third People's Hospital of Shenzhen, Editorial Committee of Chinese Journal of Tuberculosis. Expert consensus on identification criteria of pulmonary tuberculosis activity and clinical application[J]. Chin J Antituberc, 2020, 42(4): 301-307. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS202013078.htm
[16]	XIE Z, WANG T, CHEN H, et al. Factors associated with diagnostic delay in recurrent TB[J]. BMC Public Health, 2020, 20(1): 1207.