Evaluation of detection and management mode of tuberculosis patients by active screening, hospitalization in infectious phase and “centralized medication + nutritional breakfast”
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摘要:
目的 客观评价肺结核主动筛查结合传染期住院治疗与“集中服药＋营养早餐”的患者发现与管理模式（政策）在新疆维吾尔自治区（新疆）结核病疫情防治中的效果，并分析政策在不同结核病负担地区的实施效果差异，为结核病防治方案的调整及卫生干预政策的制订提供参考依据。 方法 收集阿克苏地区和巴音郭楞蒙古自治州2012年1月至2021年12月期间结核病患者登记数据，采用中断时间序列（ITS）前后对比分析政策实施前后肺结核登记率的变化，双重差分法（DID）对比分析政策在结核病高负担地区和低负担地区的实施效果差异。 结果 2012—2021年阿克苏地区肺结核登记率高于巴音郭楞蒙古自治州，阿克苏地区和巴音郭楞蒙古自治州肺结核登记率在2018年之前呈现上升趋势，在2018年达到高峰，2018年之后登记率持续快速下降。 在政策实施后当年，阿克苏地区登记率显著增加248.800/10万（P<0.001）；政策实施后的长期趋势，阿克苏地区和巴音郭楞蒙古自治州的登记率均呈现下降趋势（均β3 <0, P<0.05），阿克苏地区登记率的下降速度大于巴音郭楞蒙古自治州（ $ {\beta }_{1} $ +$ {\beta }_{3} $ ：139.747>48.712）。 阿克苏地区与对照地区之间每万人医疗机构床位数、医疗机构数、每万人医生数、人均国内生产总值、农村居民可支配收入、职工基本医疗保险存在差异，差异均有统计学意义（P<0.05），将其作为协变量构建DID模型结果显示：政策实施后，阿克苏地区政策效应与巴音郭楞蒙古自治州相比，平均政策效应差异为355.04，差异无统计学意义（P=0.205），其中，平均政策效应差异在2018和2019年有统计学意义，提示2018和2019年阿克苏地区政策干预效应大于巴音郭楞蒙古自治州。结论 在新疆结核病疫情高负担地区和低负担地区，政策对控制结核病疫情均具有降低登记率的长期效应，预期持续开展能有效遏制结核病的传播与流行。 Abstract:Objective To evaluate the performance of the detection and management mode of tuberculosis (TB) patients by active screening, hospitalization in infectious phase and “centralized medication + nutritional breakfast” in Xinjiang, and analyze the difference in the performance in areas with different TB burden and provide reference for the improvement of TB control programs and the formulation of health intervention policies in Xinjiang. Methods The registration data of TB patients in Aksu and Bayingoleng of Xinjiang from January 2012 to December 2021 were collected. Interrupted time series (ITS) was used to analyze the change of TB registration rate before and after the implementation of the TB detection and management mode. Differences-in-Differences (DID) model was used to analyze the difference in the implementation effect of the mode between high-burden areas and low-burden areas. Results From 2012 to 2021, the registration rate of TB in Aksu was higher than that in Bayingoleng. The registration rates of TB in both Aksu and Bayinguoleng showed upward trends before 2018, reached the peak in 2018, and continued to decline rapidly after 2018. In the year when the mode was taken, the TB registration rate in Aksu increased significantly by 248.800/100 000 (P<0.001); The analysis on long-term trend after the implementation of the mode indicated that the registration rates in Aksu and Bayingoleng all showed downward trends (β3<0, P<0.05), the registration rate in Aksu decreased more rapidly compared with Bayingoleng (β1+β3: 139.747>48.712). There were significant differences in the number of hospital beds per 10 000 people, number of medical institutions, number of doctors per 10 000 people, GDP per capita, disposable income of rural residents and basic medical insurance for employees between Aksu and the control area (P<0.05). The results of DID model constructed by taking them as covariates showed that after the implementation of the mode the average effect difference between Aksu and Bayinguoleng was 355.04, which had no significance (P=0.205), but the average effect difference was significant in 2018 and 2019, indicating that the intervention effects in Aksu in 2018 and 2019 were greater than those in Bayinguoleng. Conclusion In the areas with high and low TB burden in Xinjiang, the detection and management mode of TB patients by active screening, hospitalization in infectious phase and “centralized medication + nutritional breakfast” had long-term effects on reducing the registration rate of TB, and it is expected that continuous implementation of the mode can effectively curb the spread of TB. -
Key words:
- Pulmonary tuberculosis /
- Policy evaluation /
- Hospitalization /
- Registration rate /
- Active screening
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图 1 2012－2021年阿克苏地区和巴音郭楞蒙古自治州肺结核登记率时间趋势
Figure 1. Time trend chart of tuberculosis registration rate in Aksu Prefecture and Bayingoleng Mongolian Autonomous Prefecture from 2012 to 2021
图 2 2012－2021年阿克苏地区和巴音郭楞蒙古自治州基于中断时间序列模型的登记率变化趋势拟合图
Figure 2. The trend of registration rate based on the interruption time series model in Aksu Prefecture and Bayingoleng Mongolian Autonomous Prefecture from 2012 to 2021
图 3 2012－2021年阿克苏地区和巴音郭楞蒙古自治州政策干预的双重差分模型平行趋势检验
Figure 3. Parallel trend test of Differences-in-Differences model for policy intervention in Aksu Prefecture and Bayingoleng Mongolian Autonomous Prefecture from 2012 to 2021
表 1 2012－2021年阿克苏地区和巴音郭楞蒙古自治州肺结核登记率时间流行趋势
Table 1. Temporal prevalence trend of tuberculosis registration rate in Aksu Prefecture and Bayingoleng Mongolian Autonomous Prefecture from 2012 to 2021
年份 阿克苏地区 巴音郭楞蒙古自治州 登记患者数（例） 人口数 登记率（/10万） 登记患者数（例） 人口数 登记率（/10万） 2012 4509 2396877 188.12 1136 1374726 82.63 2013 4731 2457547 192.51 1121 1404151 79.83 2014 5123 2530528 202.45 1137 1398597 81.30 2015 5143 2530506 203.24 1131 1393812 81.14 2016 5341 2498167 213.80 1192 1398599 85.23 2017 6836 2522614 270.99 1455 1413740 102.92 2018 13344 2568991 519.43 2599 1388214 187.22 2019 9225 2561766 360.10 822 1492451 55.08 2020 5004 2600010 192.46 545 1519945 35.86 2021 3398 2714412 125.18 500 1613977 30.98 
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表 2 2012－2021年阿克苏地区和巴音郭楞蒙古自治州政策干预的中断时间序列模型结果
Table 2. Results of interrupted time series model of policy intervention in Aksu Prefecture and Bayingoleng Mongolian Autonomous Prefecture from 2012 to 2021
指标 回归系数 95%CI $ {s}_{\bar x} $ t值 P值 阿克苏地区 β0 177.046 140.406～213.686 14.97 11.823 <0.001 β1（干预前斜率） 13.549 1.178～25.920 5.06 2.680 0.037 β2 （干预后即时改变量） 248.800 179.696～317.903 28.24 8.810 <0.001 β3 （干预后长期趋势） −153.296 −179.872～−126.720 10.86 −14.114 <0.001 β1+β3（干预后斜率） −139.747 −164.588～−114.906 10.15 13.770 <0.001 巴音郭楞蒙古自治州 β0 74.701 35.214～114.189 16.14 4.629 0.004 β1（干预前斜率） 4.637 −8.691～17.964 5.45 0.851 0.427 β2 （干预后即时改变量） 44.221 −30.122～118.564 30.39 1.455 0.196 β3 （干预后长期趋势） −53.348 −81.961～−24.736 11.70 −4.562 0.004 β1+β3（干预后斜率） −48.712 −75.413～−22.010 10.91 −4.460 0.004 注：CI. 置信空间
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表 3 政策干预前（2012－2017年）阿克苏地区与巴音郭楞蒙古自治州登记率及协变量比较
Table 3. Comparison of registration rate and covariates between Aksu Prefecture and Bayingoleng Mongolian Autonomous Prefecture before policy intervention (2012−2017)
变量 巴音郭楞蒙古自治州均值 阿克苏地区均值 差值 t值 P值 登记率（/10万） 85.508 211.852 126.343 9.801 <0.001 每万人医疗机构床位数a 0.178 −0.432 −0.610 4.906 <0.001 医疗机构数（个） −0.178 0.255 0.433 4.924 0.003 卫生技术人员（例） −0.132 −0.013 0.120 2.205 0.070 每万人医生数（例） 0.097 −1.098 −1.195 6.855 <0.001 农业人口比例 −0.280 0.402 0.682 1.721 0.116 人均国内生产总值（万元） 0.667 −0.588 −1.255 16.412 <0.001 城镇居民可支配收入（元/人） 0.085 −0.193 −0.278 0.583 0.573 农村居民可支配收入（元/人） 0.280 −0.517 −0.797 2.378 0.039 职工基本医疗保险（万人） 0.057 −0.245 −0.303 2.662 0.037 城乡居民基本医疗保险（万人） −0.050 0.447 0.497 0.692 0.515 全年平均气温（℃） 0.633 0.378 −0.255 1.920 0.084 全年平均降水（mm） −0.653 −0.577 0.077 0.363 0.724 全年平均日照时长（h） 0.553 0.677 0.123 0.565 0.585 注：a. 所有协变量均进行标准化变换
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表 4 2012－2021年阿克苏地区和巴音郭楞蒙古自治州政策干预的双重差分模型结果
Table 4. Results of Differences-in-Differences for policy interventions in Aksu Prefecture and Bayingoleng Mongolian Autonomous Prefecture from 2012 to 2021
指标 登记率（/10万） $ {s}_{\bar x} $ t值 P值 政策实施前 控制地区效应值 95.27 干预地区效应值 166.01 差分 70.74 492.14 0.144 0.893 政策实施后 控制地区效应值 −77.93 干预地区效应值 347.85 差分 425.78 583.59 0.730 0.506 DID 政策效应 355.04 234.98 1.511 0.205
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