Comparison of results of two surveys of underreporting of pulmonary tuberculosis in county-level medical institutions in Yunnan

  Objective  To evaluate the changes of underreporting of pulmonary tuberculosis (TB) before and after the transformation of TB prevention and control service model in Yunnan province, provide scientific data support for accurately assessing the prevalence of pulmonary TB in Yunnan and provide reference for improving the quality of pulmonary TB reporting in medical institutions.

  Methods  According to the national unified investigation protocol of underreporting of pulmonary tuberculosis, the probability proportional sampling method (PPS) was used to select county-level medical institutions in Yunnan in 2015 and 2020. The patients diagnosed with pulmonary TB in the medical institutions were investigated and analyzed, and the underreporting of pulmonary TB was evaluated. The difference of underreporting between groups was compared by χ² test, and the difference of underreporting of pulmonary TB patients was taken as the dependent variable, and multivariate analysis was performed by logistic regression equation.

  Results  The overall underreporting rate of pulmonary TB was 25.10% in 2015 and 1.71% in 2020, the difference was significant (χ²=1092.742, P<0.001). The results of the multivariate analysis showed that non-designated institutions Adjusted Odds Rito(aOR)=11.118,95% Confidence Interval(CI):8.582–14.405, hospitalization (aOR=1.404, 95%CI: 1.111–1.774), no etiological results (aOR=2.212, 95%CI: 1.176–4.161), tuberculous pleurisy (aOR=9.398, 95%CI: 5.595–15.789) and area with high TB incidence (aOR=1.899, 95%CI: 1.543 –2.337) were the risk factors of the underreporting in 2015 (all P<0.05), Young age (aOR=4.363, 95%CI: 1.250–15.321), no etiological results (aOR=52.531, 95%CI: 26.184–105.386) and area with high TB incidence (aOR=2.040, 95%CI: 1.146–3.629) were the risk factors of the underreporting in 2020 (all P<0.05).

  Conclusion  The development of new TB prevention and control service mode is conducive to improve the quality of pulmonary TB reporting in medical institutions at county level in Yunnan, and the improvement of pathogen positive rate and the reporting responsibility of designated medical institutions were the main reasons for reducing the underreporting of pulmonary TB. In the future TB prevention and control, it is still necessary to pay attention to the reporting of pulmonary TB patients in medical institutions, especially the patients at young age, in areas with high TB incidences and without etiological detection results, and continue to reduce the underreporting of pulmonary TB in medical institutions.