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2014－2023年西藏自治区肺结核报告发病流行特征和变化趋势分析

Analysis of epidemiological characteristics and incidence trend of pulmonary tuberculosis in Xizang Autonomous Region, 2014–2023

    摘要
  • 摘要:
    目的  探讨2014—2023年西藏自治区（西藏）肺结核流行特征及趋势演变，为高原地区精准防控策略制定提供科学依据。
    方法  从中国疾病预防控制信息系统子系统传染病报告信息管理系统收集2014—2023年西藏肺结核报告发病监测数据，描述性统计分析人群的性别、年龄和职业特征；并应用Joinpoint 5.3.0软件对全人群、不同性别、年龄组及地区肺结核报告发病率、不同职业报告发病数构成比和病原学阳性率进行趋势性分析。
    结果  2014—2023年西藏共报告肺结核患者51872例，年均报告发病率152.06/10万，报告发病率呈下降趋势平均年度变化百分比（AAPC）= −5.58%，2019年后降速加快年度变化百分比（APC）= −14.85%；昌都市年均报告发病率最高（251.20/10万）。 男性年均报告发病率（163.30/10万）高于女性（140.27/10万）（χ2＝297.604，P＜0.001）；在全年龄组中，男性的报告发病风险是女性的0.86～2.23倍，且随年龄递增；肺结核报告发病年龄风险呈现双峰分布，分别为15～＜25岁（309.35/10万）和≥65岁（296.91/10万）；0～＜15岁儿童报告发病率高达36.34/10万；报告病原学阳性率从2014年的21.26%上升至2023年的46.08%（AAPC = 8.14%）；职业分布中居前3位的依次是农民（26993例，占52.04%）、学生（11682例，占22.52%）和牧民（5321例，占10.26%），报告发病数构成比中农民呈持续下降趋势（AAPC=APC = −1.67%），学生呈先升后降趋势（2014—2021年APC=8.97%，2021—2023年APC= −19.97%），牧民呈先降后升趋势（2014—2021年APC= −5.60%，2021—2023年APC=29.64%）。
    结论  2014—2023年西藏肺结核报告发病率总体下降但仍高于全国平均水平。需分类施策，加强农牧区结核病防控、性别差异化干预，开展学生主动筛查及预防性治疗，推进老年人群重点监测，推广分子诊断，提升检测和防治能力，有效遏制高原地区结核病的流行。

     

    Abstract:
    Objective To investigate the epidemiological characteristics and incidence trend of pulmonary tuberculosis (TB) in Xizang Autonomous Region(Xizang) during 2014–2023 and provide evidence for the development of targeted prevention strategies in high-altitude region.
    Methods Pulmonary TB surveillance data in Xizang during 2014-2023 were collected from the infectious disease reporting subsystem of China Disease Prevention and Control Information System for a descriptive analysis on the gender, age, and occupation distributions of pulmonary TB cases. Joinpoint regression was used to analyze the temporal trends of overall and gender/age/area-specific incidence rates, occupation distribution, and laboratory confirmation rate of pulmonary TB in Xizang during this period.
    Results A total of 51 872 pulmonary TB cases were reported in Xizang during 2014−2023, with an average annual incidence of 152.06/100 000. The overall incidence exhibited a declining trend average annual percent change (AAPC) = −5.58% and rapid decline after 2019 annual percent change (APC) = −14.85%. Changdu had the highest annual reported incidence rate (251.20/100000). The incidence rate in men (163.30/100 000) was significantly higher than that in women (140.27/100 000) ( χ2 = 297.604, P＜0.001), the incidence risk was 0.86−2.23 times higher in men than in women in all age groups. Two incidence peaks were observed: in age groups 15−＜25 years (309.35/100000) and ≥65 years (296.91/100 000). The incidence rate was high in children aged 0−＜15 years (36.34/100000). The laboratory confirmation rate increased from 21.26% in 2014 to 46.08% in 2023 (AAPC = 8.14%). Occupation distribution analysis indicated that farmers (26993 cases, 52.04%), students (11682 cases, 22.52%), and herdsmen (5321 cases, 10.26%) were the top three groups affected. The case proportion continued to decrease in farmers (AAPC = APC = −1.67%). The case proportion initially increased during 2014–2021 (APC=8.97%), then decreased during 2021–2023 (APC = −19.97%) in students, and decreased during 2014–2021 (APC = −5.60%) then increased during 2021–2023 (APC = 29.64%) in herdsmen.
    Conclusion The reported pulmonary TB incidence declined in Tibet from 2014 to 2023, but it remained above national level. It is necessary to take classified measures to strengthen TB control in agricultural/pastoral areas, conduct gender specific intervention and active screening and preventive treatment in students, promote the surveillance in the elderly, and expand molecular diagnosis coverage to improve detection capacity and curb TB transmission in plateau region.

     

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