Registration of pulmonary tuberculosis complicated with diabetes mellitus over time in Heilongjiang, 2017−2021
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摘要:
目的 了解黑龙江省肺结核合并糖尿病登记率及变化趋势,为今后制定相应防治政策提供依据。 方法 通过《结核病信息管理系统》收集黑龙江省2017—2021年肺结核合并糖尿病患者信息资料,采用描述流行病学方法分析患者一般人口学特征、患者来源、治疗分类、病原学诊断、药敏试验结果等,应用Jointpoint回归模型分析黑龙江省及其13个行政地级市(地区)肺结核合并糖尿病年登记率的变化趋势。 结果 2017—2021年黑龙江省共登记肺结核合并糖尿病患者5 816例(年均登记率3.31/10万),年登记率从2017年的2.22/10万上升至2021年的4.65/10万,年度变化百分比(APC)呈上升趋势(APC=17.01%,95%CI:4.45%~31.08%,t=4.401,P=0.022);13个行政地级市(地区)中哈尔滨市呈上升趋势(APC=23.85%,95%CI:18.83%~29.14%,t=16.387,P<0.01),伊春市呈下降趋势(APC=−81.04%,95%CI:−94.19%~−37.24%,t=−4.428,P=0.021),其他地市年登记率变化趋势差异无统计学意义(P>0.05)。 5 816例患者中,男性(4 554例,78.30%)、45~54岁年龄组(1 818例,31.26%)、家务及待业(3 214例,55.26%)为主;患者类型中以直接就诊(4 437例,76.29%)、初治(4 662例,80.16%)、病原学阳性(3 914例,67.30%)、药敏试验结果敏感(2 519例,43.31%)患者为主。 结论 黑龙江省肺结核与糖尿病共病登记率呈上升趋势,且地区间流行呈现不平衡性,应对结核病与糖尿病共病防治工作给予重视。 Abstract:Objective To analyze the registration level of pulmonary tuberculosis complicated with diabetes mellitus (PTB-DM) in Heilongjiang province from 2017 to 2021, and provide scientific evidence for the development of corresponding prevention and treatment strategies. Methods The data of PTB-DM patients in Heilongjiang between 2017 and 2021 were collected from the Tuberculosis Information Management System. Descriptive epidemiological method was used to analyze the demographic characteristics of the patients, source of the patients, classification of treatment, etiological diagnosis and drug susceptibility testing results. Joint point regression model was applied to analyze the trend of the annual registration rate of PTB-DM in Heilongjiang and its 13 prefectures. Results A total of 5 816 PTB-DM were registered in Heilongjiang from 2017 to 2021, with average annual registration rate of 3.31/100 000. The annual registration rate increased from 2.22/100 000 to 4.65/100 000 during this period, showing an upward trend of annual percentage change (APC) (APC=17.01%, 95%CI: 4.45%–31.08%, t=4.401, P=0.022). Among the 13 prefectures, the registration rate showed an upward trend in Harbin (APC=23.85%, 95%CI: 18.83%–29.14%, t=16.387, P<0.01), showed a downward trend in Yichun (APC=−81.04%, 95%CI: −94.19%–−37.24%, t=−4.428, P=0.021), while there were no significant difference in the change of the annual registration rate among other prefectures (P>0.05). Of 5 816 PTB-DM patients, 78.30% were males (4 554/5 816), 31.26% were in age group 45–54 years (1 818/5 816), and 55.26% were the jobless or unemployed (3 214/5 816). Of the PTB-DM patients, 76.29% sought medical care directly (4 437/5 816), 80.16% (4 662/5 816) had initial treatment, 67.30% were etiological positive (3 914/5 816), 43.31% showed sensitive drug susceptibility testing results (2 519/5 816). Conclusion The registration rate of PTB-DM was in increase in Heilongjiang, but area specific differences were observed. Attention should be paid to the prevention and treatment of PTB-DM. -
Key words:
- Tuberculosis /
- Pulmonary /
- Diabetes mellitus /
- Comorbidity /
- Epidemiological characteristic
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表 1 2017-2021年黑龙江省肺结核合并糖尿病患者年登记率
Table 1. Annual registration rate of PTB-DM in Heilongjiang, 2017−2021
年份 肺结核 肺结核合并糖尿病 例数 年登记率(/10万) 例数 占比(%) 年登记率(/10万) 2017 27 161 74.23 811 2.99 2.22 2018 24 279 67.43 1 082 4.46 3.01 2019 22 291 62.36 1 264 5.67 3.54 2020 15 642 44.01 1 185 7.58 3.33 2021 16 214 51.13 1 474 9.09 4.65 合计 105 587 60.13 5 816 5.51 3.31 表 2 2017-2021年黑龙江省肺结核合并糖尿病患者与活动性肺结核患者人口学特征和不同分类对比
Table 2. Demographic characteristics and classification of PTB-DM and active PTB patients in Heilongjiang, 2017−2021
组别 肺结核合并糖尿病(n=5 816) 活动性肺结核(n=105 587) 例数 构成比(%) 例数 构成比(%) 性别 男性 4 554 78.3 71 912 68.11 女性 1 262 21.7 33 675 31.89 年龄组(岁) 0~ 50 0.86 10 252 9.71 25~ 306 5.26 12 637 11.97 35~ 773 13.29 13 277 12.57 45~ 1 818 31.26 25 157 23.83 55~ 1 739 29.90 22 562 21.37 65~ 789 13.57 14 048 13.30 ≥75 341 5.86 7 654 7.25 职业 家务及待业 3 214 55.26 45 935 43.50 农民和新产业工人 1 290 22.18 37 864 35.86 离退人员 664 11.42 7 072 6.70 工人 244 4.20 3 424 3.24 职员 192 3.30 2 443 2.31 商业服务者 29 0.50 863 0.82 学生及儿童 23 0.39 3 833 3.63 其他 160 2.75 4 153 3.94 患者来源 直接就诊 4 437 76.29 63 543 60.18 转诊 897 15.42 20 327 19.25 追踪 364 6.26 18 495 17.52 健康体检 54 0.93 1 333 1.26 推介 50 0.86 1 098 1.04 其他 14 0.24 791 0.75 治疗分类 初治 4 662 80.16 93 411 88.47 复治 1 154 19.84 12 176 11.53 病原学诊断 阳性 3 914 67.30 44 377 42.03 阴性 1 629 28.01 57 226 54.20 结核性胸膜炎和无结果 273 4.69 3 984 3.77 药物敏感性a 敏感 2 519 77.96 28 538 84.42 单耐利福平 200 6.19 1 480 4.38 单耐异烟肼 276 8.54 2 263 6.69 耐多药 236 7.31 1 524 4.51 注:a.由于肺结核和肺结核合并糖尿病患者中仅有部分患者具有药敏试验结果,因此两者药敏试验结果的“敏感”、“单耐利福平”、“单耐异烟肼”、“耐多药”的比率计算均以具有药敏结果的数据计算 表 3 2017-2021年黑龙江省13个地市(地区)肺结核合并糖尿病患者年登记率变化趋势
Table 3. Trend of the annual registration rate of PTB-DM in 13 prefectures of Heilongjiang, 2017−2021
地级市
(地区)2017年
(n=811例)2018年
(n=1 082例)2019年
(n=1 264例)2020年
(n=1 185例)2021年
(n=1 474例)合计
(n=5 816例)2017-2021年 例数 年登记率(/10万) 例数 年登记率(/10万) 例数 年登记率(/10万) 例数 年登记率(/10万) 例数 年登记率(/10万) 例数 年平均
登记率
(/10万)APC (%)a 95%CI(%) t值 P值 哈尔滨市 421 4.38 547 5.73 688 7.23 783 8.23 1065 10.65 3504 7.27 23.85 18.83~29.14 16.387 <0.001 齐齐哈尔市 52 0.96 149 2.79 177 3.34 64 1.22 32 0.79 474 1.87 −11.34 −56.83~82.09 −0.532 0.631 鸡西市 25 1.38 93 5.31 109 6.31 82 4.84 104 6.96 413 4.87 36.85 −16.93~125.46 2.001 0.139 鹤岗市 65 6.27 41 4.06 45 4.52 53 5.38 72 8.12 276 5.62 8.29 −18.34~43.59 0.898 0.435 佳木斯市 22 0.93 41 1.75 57 2.44 52 2.24 49 2.28 221 1.92 22.76 −6.44~61.06 2.403 0.096 绥化市 53 0.98 37 0.70 37 0.71 29 0.56 26 0.70 182 0.73 −8.58 −22.44~7.75 −1.737 0.181 牡丹江市 30 1.16 51 2.00 27 1.07 32 1.28 34 1.49 174 1.40 0.59 −24.55~34.10 0.065 0.952 黑河市 34 2.09 41 2.55 24 1.51 35 2.21 14 1.10 148 1.93 −13.34 −35.56~16.53 −1.539 0.221 大庆市 58 2.09 14 0.50 18 0.65 13 0.47 41 1.47 144 1.04 −7.32 −56.92~99.38 −0.316 0.773 双鸭山市 10 0.69 36 2.53 34 2.41 26 1.85 17 1.41 123 1.79 11.78 −37.35~99.44 0.612 0.584 七台河市 29 3.62 20 2.54 42 5.41 12 1.56 16 2.34 119 3.12 −12.78 −46.30~41.67 −0.897 0.436 大兴安岭地区 7 1.55 11 2.51 5 1.16 4 0.96 4 1.22 31 1.50 −13.39 −38.24~21.47 −1.352 0.269 伊春市 5 0.43 1 0.09 1 0.09 0 0.00 0 0.00 7 0.13 −81.04 −94.19~−37.24 −4.428 0.021 注:a. Jointpoint回归模型趋势变化主要计算指标为年度变化百分比(annual percentage change,APC),APC表示为因变量平均每年变化的百分比,P<0.05为差异有统计学意义 -
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