Sampling survey of under-registration of pulmonary tuberculosis and influencing factors in Hubei, 2019
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摘要:
目的 了解2019年湖北省肺结核漏登情况的影响因素及原因。 方法 采用分层随机抽样抽取湖北省(县、市)具有肺结核诊断能力的定点及非定点医疗机构,对其2019年诊断为肺结核和疑似肺结核病例进行调查,评估漏登情况。 结果 共收集6家医疗机构21 591条信息,最终核查分析肺结核患者3 285例。 2019年湖北省肺结核漏登率为10.23%。 不同诊疗机构属性(χ2=42.933,P<0.001)、机构类型(χ2=6.747,P=0.009)、诊断分类(χ2=18.266,P<0.001)、地区疫情程度(χ2=21.989,P<0.001)及年均门诊量(χ2=24.053,P<0.001)的漏登率不同,差异有统计学意义。 市级漏登风险较高(与县级相比,OR=2.27,95%CI:1.77~2.92),结核性胸膜炎漏登风险较高(相较于利福平耐药肺结核,OR=6.71,95%CI:1.90~23.74)。 追踪未到位和一次性就诊是主要漏登原因。 结论 关注湖北省肺结核漏登问题,继续提升结核病防治体系服务能力,强化各级医院的规范诊疗服务水平。 Abstract:Objective To understand the under-registration of pulmonary tuberculosis (TB) and analyze the influencing factors and reasons in Hubei province in 2019. Methods A stratified random sampling method was used to select designated and non-designated tuberculosis medical institutions with tuberculosis diagnosis capabilities in counties and cities of Hubei to conduct a survey of registration of pulmonary TB cases and suspected pulmonary TB cases in 2019, and evaluate the status of the under-registration. Results The information of 21591 pulmonary TB cases were collected from 6 medical institutions, finally, the information of 3285 cases were analyzed. In 2019, the under-registration rate of pulmonary TB in Hubei was 10.23%. There were statistically significant differences in under- registration rate among the institutions with different nature (χ2=42.933, P<0.001), institutions of different types (χ2=6.747, P=0.009), cases with different diagnosis classification (χ2=18.266, P<0.001), areas with different epidemic situation (χ2=21.989, P<0.001) and hospitals with different outpatient visits (χ2=24.053, P<0.001). The risk for under-registration of pulmonary TB was higher at city level (compared with the county level, OR=2.27, 95%CI: 1.77−2.92) and in tuberculous pleurisy cases (compared with rifampicin-resistant tuberculosis cases, OR=6.71, 95 %CI: 1.90−23.74). Failure to follow up and one-off visits were the main reasons for the under-registration of pulmonary TB. Conclusion It is necessary to pay attention to the under-registration of pulmonary TB, improve the service capacity of the TB prevention and control system, and strengthen the standardized diagnosis and treatment of pulmonary TB in hospitals in Hubei. -
Key words:
- Tuberculosis, Pulmonary /
- Underreporting /
- Influencing factors /
- Surveillance
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表 1 肺结核患者一般特征
Table 1. Characteristics of pulmonary TB cases
特 征 病例数(例) 构成比(%) 年龄组(岁) 0~ 26 0.79 15~ 2 520 76.71 ≥65 739 22.50 性别 男性 2 285 69.56 女性 1 000 30.44 机构类型 市级定点 1 343 40.88 县/区级定点 1 445 43.99 市级非定点 490 14.92 县/区级非定点 7 0.21 诊断分类 利福平耐药肺结核 64 1.95 肺结核(除外单纯性胸膜炎) 3129 95.25 单纯结核性胸膜炎 92 2.80 病原学检查结果 病原学阴性 1 596 48.58 病原学阳性 1 506 45.85 利福平耐药 64 1.95 无病原学检查结果 119 3.62 资料来源 病房 1 865 56.77 检验 90 2.74 门诊 1 330 40.49 机构年均门诊量(人次) ≥10 000 2 558 77.87 <10 000 727 22.13 就诊地区 宜昌市 490 14.92 十堰市 1 343 40.88 巴东县 725 22.07 石首市 720 21.92 郧西县 2 0.06 曾都区 5 0.15 合 计 3 285 100.00 表 2 肺结核病例漏登的相关因素
Table 2. Factors associated with under-registration of pulmonary TB cases in Hubei
特 征 病例数(例) 漏登数(例) 漏登率(%) χ2值 P值 OR值(95% CI) P值 年龄组(岁) 5.043 0.080 0~ 26 6 23.08 1.00 0.114 15~ 2520 251 9.96 0.207 ≥65 739 79 10.69 0.390 性别 0.706 0.401 男性 2285 227 9.93 1.00 女性 1000 109 10.90 0.381 机构属性 42.933 <0.001 区/县级 1452 92 6.34 1.00 市级 1833 244 13.31 2.27(1.77~2.92) <0.001 机构类型 6.747 0.009 定点 2788 269 9.65 1.00 非定点 497 67 13.48 0.942 诊断分类 18.266 <0.001 利福平耐药肺结核 64 3 4.69 1.00 肺结核(除外单纯性胸膜炎) 3129 312 9.97 2.42(0.75~7.77) 0.139 单纯结核性胸膜炎 92 21 22.83 6.71(1.90~23.74) 0.003 资料来源 2.410 0.300 病房 1865 179 9.60 1.00 0.240 检验 90 12 13.33 0.243 门诊 1330 145 10.90 0.293 疫情程度 21.989 <0.001 高疫情地区 725 53 7.31 1.00 0.235 中疫情地区 1212 106 8.75 0.337 低疫情地区 1348 177 13.13 0.967 年均门诊量(人次) 24.053 <0.001 ≥10 000 2558 297 11.61 1.00 <10 000 727 39 5.36 0.089 合 计 3 285 336 10.23 表 3 肺结核病例漏登的主要原因
Table 3. Main reasons of under-registration of pulmonary TB cases in Hubei
特征 漏登数
(例)追踪未到位 一次性就诊 未报告 复治菌阴 拒绝/不宜治疗/
死亡/在外地治疗机构属性 市级 244 144(59.02) 60(24.59) 19(7.79) 12(4.92) 9(3.69) 区/县级 92 20(21.74) 15(16.30) 28(30.43) 16(17.39) 13(14.13) 机构类型 定点 269 127(47.21) 59(21.93) 41(15.24) 26(9.67) 16(5.95) 非定点 67 37(55.22) 16(23.88) 6(8.96) 2(2.99) 6(8.96) 疫情程度 高疫情地区 53 19(35.85) 10(18.87) 7(13.21) 12(22.64) 5(9.43) 中疫情地区 106 38(35.85) 21(19.81) 27(25.47) 6(5.66) 14(13.21) 低疫情地区 177 107(60.45) 44(24.86) 13(7.34) 10(5.65) 3(1.69) 年均门诊量(人次) ≥10 000 297 163(54.88) 70(23.57) 26(8.75) 24(8.08) 14(4.71) <10 000 39 1(2.56) 5(12.82) 21(53.85) 4(10.26) 8(20.51) 合计 336 164(48.81) 75(22.32) 47(13.99) 28(8.33) 22(6.55) 注:括号外数据为漏登数(例),括号内数据为漏登原因占比(%) -
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