基于调整Serfling回归模型的2014－2023年北京市朝阳区肺结核流行特征及超额病例分析

梁瑞英; 张爱洁; 吴冬雪; 杨智斌; 余琴; 孙灵利; 王小莉; 徐伟

doi:10.3784/jbjc.202411130652

基于调整Serfling回归模型的2014－2023年北京市朝阳区肺结核流行特征及超额病例分析

Analysis on epidemiological characteristics and excess cases of pulmonary tuberculosis with adjusted Serfling regression model in Chaoyang district, Beijing, 2014 - 2023

摘要

摘要:
目的分析2014—2023年北京市朝阳区肺结核流行特征及变化规律，构建调整 Serfling 回归模型估计超额肺结核病例数，为肺结核疫情监测分析和防控提供依据。
方法利用中国疾病预防控制信息系统的2014—2023年北京市朝阳区报告肺结核病例数据，进行肺结核流行特征描述性分析，并应用调整 Serfling 回归模型拟合，估计朝阳区报告肺结核流行期及超额病例数。
结果 2014—2023年北京市朝阳区报告肺结核病例数13 205例，其中肺结核病原学阳性比例为41.17%，呈增加趋势（Z= 4.395, P<0.001），尤其是2019年后。报告病例以男性（61.55%）和青年组（15～＜30岁，32.15%）为主。朝阳区报告肺结核发病率呈下降趋势（Z=−2.116，P=0.034），在男性45.28/10万，四分位数间距（IQR）：37.12/10万，48.76/10万和≥75岁组（104.70/10万，IQR：101.50/10万，118.56/10万）较高，且均呈下降趋势（Z_男性=−2.816, P=0.005；Z_≥75岁=−3.559, P<0.001），青年组发病率亦较高（55.00/10万，IQR：44.40/10万，55.30/10万），但下降趋势无显著性（Z=−1.232，P=0.218）；青年组患者占比下降（Z=−4.567, P<0.001）而老年组患者（60～岁）占比增加（Z=2.947, P=0.003）。 Serfling 回归模型拟合效果较好（R²=0.83），朝阳区肺结核疫情具有一定季节性，3月是固定流行月，而2020—2022年流行月份与往年不同，其中2021年流行月较多；朝阳区肺结核超额病例数为1245例（95%CI：473～2016例），超额比例为37.46%（95%CI：18.54%～49.25%），2020—2022年超额病例增加，占总超额病例的42.97%（95%CI：42.36%～45.56%）。
结论 2014—2023年北京市朝阳区肺结核疫情呈下降趋势，需关注春季、青年及老年人群的结核病防控和宣教。调整Serfling 回归模型能较好拟合朝阳区报告肺结核病例数变化趋势，2020—2022年朝阳区肺结核疾病负担增加，建议加强肺结核疫情监测和防控力度。

Abstract:
Objective To analyze the epidemiological characteristics and incidence trend of pulmonary tuberculosis (TB) in Chaoyang district, Beijing, from 2014 to 2023, construct an adjusted Serfling regression model for estimating the number of excess pulmonary TB cases, and provide evidence for surveillance, analysis, and control of pulmonary TB.
Methods The incidence data pulmonary TB reported in Chaoyang from 2014 to 2023 were obtained from China Disease Prevention and Control Information System for a descriptive analysis on the epidemiological characteristics of pulmonary TB in Chaoyang, and the adjusted Serfling regression model was used to estimate the epidemic period and the number of excess pulmonary TB cases in Chaoyang.
Results A total of 13 205 pulmonary TB cases were reported in Chaoyang from 2014 to 2023. The proportion of etiologically positive pulmonary TB cases showed an increasing trend (Z=4.395, P < 0.001), especially after 2019. The majority of the reported cases was men (61.55%) and aged 15-＜30 years (32.15%). The reported incidence rate of pulmonary TB showed a decreasing trend (Z=−2.116, P=0.034), with higher incidence rates observed in men 45.28/100 000,interquartile range (IQR): 37.12/100 000, 48.76/100 000 and the elderly (≥75 years, 104.70/100 000, IQR: 101.50/100 000, 118.56/100 000), both showed declining trends (men Z=-2.816, P=0.005; the elderly Z=−3.559, P < 0.001). The incidence rate in the young age group (15-＜30 year) was also high (55.00/100 000, IQR: 44.40/100 000, 55.30/100 000), but the decreasing trend was without significance (Z=−1.232, P=0.218). The proportion of the patients in the young age group (15-＜30 year) decreased (Z=−4.567, P < 0.001), while the proportion of the patients in the elderly group (60- years old) increased (Z=2.947, P=0.003). The Serfling regression model fitted well (R²=0.83), indicating a seasonal pattern of pulmonary TB in Chaoyang, with the incidence peak in March. From 2020 to 2022, the epidemic period differed from previous years, with more peak months observed in 2021. The number of excess pulmonary TB cases in Chaoyang was 1 245 (95%CI: 473-2 016), representing an excess proportion of 37.46% (95%CI: 18.54%-49.25%). The number of the excess cases increased during 2020 - 2022, accounting for 42.97% (95%CI: 42.36%-45.56%) of the total excess cases.
Conclusion The incidence of pulmonary TB in Chaoyang showed a decreasing trend from 2014 to 2023. Attention should be paid to TB prevention, control, and health education in spring and in young and elderly populations. The adjusted Serfling regression model provided a good fit for the trend of pulmonary TB incidence in Chaoyang. The burden level of pulmonary TB in Chaoyang increased during 2020-2022. It is suggested to strengthen the surveillance and control of TB.

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