新疆维吾尔自治区和田地区“肺结核主动筛查+全疗程住院治疗”模式对患者发现的效果

doi:10.19982/j.issn.1000-6621.20230284

中国防痨杂志 ›› 2024, Vol. 46 ›› Issue (2): 145-150.doi: 10.19982/j.issn.1000-6621.20230284

新疆维吾尔自治区和田地区“肺结核主动筛查+全疗程住院治疗”模式对患者发现的效果

张燕¹, 王森路², 日孜宛古力·热合曼³, 刘年强², 王新旗², 毛宏凯¹, 王小敏¹, 曹明芹¹()

¹新疆医科大学公共卫生学院,乌鲁木齐 830011
²新疆维吾尔自治区疾病预防控制中心结核病与麻风病防治中心,乌鲁木齐 830002
³新疆维吾尔自治区和田地区疾病预防控制中心, 和田 848000

收稿日期:2023-08-11 出版日期:2024-02-10 发布日期:2024-01-30
通信作者: 曹明芹 E-mail:573596229@qq.com
基金资助:
新疆维吾尔自治区研究生科研创新项目(XJ2023G188)

Evaluation of the implementation effect of “Active Tuberculosis Screening+Full-Course Hospitalization” model for patient detection in Hotan Prefecture, Xinjiang Uygur Autonomous Region

Zhang Yan¹, Wang Senlu², Rizwanguli Rehman³, Liu Nianqiang², Wang Xinqi², Mao Hongkai¹, Wang Xiaomin¹, Cao Mingqin¹()

¹School of Public Health, Xinjiang Medical University, Urumqi 830011, China
²Tuberculosis and Leprosy Prevention and Control Centre, Xinjiang Uygur Autonomous Region Centre for Disease Control and Prevention, Urumqi 830002, China
³Hotan Prefecture Center for Disease Control and Prevention, Xinjiang Uygur Autonomous Region, Hotan 848000, China

Received:2023-08-11 Online:2024-02-10 Published:2024-01-30
Contact: Cao Mingqin E-mail:573596229@qq.com
Supported by:
Xinjiang Uygur Autonomous Region Postgraduate Scientific Research Innovation Project(XJ2023G188)

摘要/Abstract

摘要： 目的: 定量评价“肺结核主动筛查+全疗程住院治疗”模式在新疆维吾尔自治区(简称“新疆”)和田地区肺结核患者发现中的实施效果,为新疆肺结核防治工作的稳步推进提供科学依据。方法: 收集2012年1月至2021年12月新疆和田地区及未实施全疗程住院治疗策略的新疆其他地州肺结核报告发病数据。利用Joinpoint回归模型分析肺结核报告发病率的时间趋势。以2018年7月作为“肺结核主动筛查+全疗程住院治疗”模式干预时间点,根据是否设置对照地区,分别构建单组中断时间序列(interrupted time series,ITS)模型和设置对照的ITS模型(controlled interrupted time series,CITS)分析政策干预效果。结果: 2012—2021年新疆和田地区肺结核报告发病率最高为2018年的465.10/10万(10278例),最低为2021年的129.40/10万(3241例),总体呈现下降趋势(AAPC=-4.5%,P<0.05);2012—2018年肺结核报告发病率呈现上升趋势(APC=10.8%,P<0.05),2018—2021年肺结核报告发病率呈快速下降趋势(APC=-29.0%,P<0.05)。ITS模型分析显示,和田地区实施“肺结核主动筛查+全疗程住院治疗”模式后1个月(2018年7月),报告发病率增加16.859/10万(P=0.001),新型模式实施后的长期效果为肺结核报告发病率呈下降趋势(β₃=-1.098,P<0.001)。CITS模型分析显示,和田地区在新型模式实施后1个月(2018年7月),肺结核报告发病率明显增加,增加量比对照地区高14.751/10万(P<0.001),新型模式实施后长期效果为肺结核报告发病率呈下降趋势,平均每月下降0.815/10万(β₅+β₇=-0.815, P<0.001),下降速度大于对照地区(β₇=-0.931,P<0.001)。结论: 新疆和田地区实施“肺结核主动筛查+全疗程住院治疗”模式与肺结核报告发病率之间存在动态因果关系,该模式促使肺结核报告发病率在短暂地上升后呈现下降的长期趋势。实施该模式对控制结核病高负担地区肺结核疫情具有明显优势。

关键词: 结核,肺, 卫生政策, 结果评价(卫生保健), 模型,统计学

Abstract: Objective: To quantitatively evaluate the effectiveness of the “Active Tuberculosis Screening+Full-Course Hospitalization” model in the detection of tuberculosis patients in Hotan Prefecture of Xinjiang Uygur Autonomous Region, and to provide a scientific basis for the steady advancement of tuberculosis prevention and treatment in Xinjiang. Methods: The reported incidence data of tuberculosis patients in Hotan Prefecture of Xinjiang and other prefectures without full-course hospitalization strategy from January 2012 to December 2021 were collected. Joinpoint regression model was used to analyze the time trend of reported incidence of tuberculosis. Taking July 2018 as the policy intervention time point of the “Active Tuberculosis Screening+Full-Course Hospitalization” model, the interrupted time series (ITS) model and controlled interrupted time series (CITS) model were constructed according to whether the control area was set up or not, to analyze the effect of policy intervention. Results: The highest reported incidence of tuberculosis in Hotan Prefecture from 2012 to 2021 was 465.10/100000 (n=10278) in 2018, and the lowest incidence was 129.40/100000 (n=3241) in 2021, with an overall decreasing trend (AAPC=-4.5%, P<0.05); reported incidence of tuberculosis from 2012 to 2018 showed an increasing trend (APC=10.8%, P<0.05), while reported incidence of tuberculosis from 2018 to 2021 showed a rapid decreasing trend (APC=-29.0%, P<0.05). The ITS model analysis showed that one month after the implementation of the “Active Tuberculosis Screening+Full-Course Hospitalization” model in Hotan Prefecture (July, 2018), the reported incidence increased by 16.859/100000 (P=0.001), and the long-term effect of the implementation of the new model was a decreasing trend in the reported incidence of tuberculosis (β₃=-1.098, P<0.001). The CITS model analysis showed that reported incidence of tuberculosis in Hotan Prefecture increased significantly one month after the implementation of the new model (July, 2018), with an increase of 14.751/100000 (P<0.001) higher than that in the control area, and the long-term effect of the implementation of the new model was a decreasing trend in the reported incidence of tuberculosis, with an average monthly decrease of 0.815/100000 (β₅+β₇=-0.815, P<0.001), and the rate of decline was greater than that in the control area (β₇=-0.931, P<0.001). Conclusion: There is a dynamic causal relationship between the implementation of the “Active Tuberculosis Screening+Full-Course Hospitalization” model and reported incidence of tuberculosis in the Hotan Prefecture of Xinjiang, and the new model has contributed to a long-term trend of decreasing reported incidence after a short-lived increase. The implementation of this model has obvious advantages for controlling tuberculosis epidemics in areas with a high tuberculosis burden.

Key words: Tuberculosis, pulmonary, Health policy, Outcome assessment (Health Care), Models, Statistical

中图分类号:

R521
R183.3

张燕, 王森路, 日孜宛古力·热合曼, 刘年强, 王新旗, 毛宏凯, 王小敏, 曹明芹. 新疆维吾尔自治区和田地区“肺结核主动筛查+全疗程住院治疗”模式对患者发现的效果[J]. 中国防痨杂志, 2024, 46(2): 145-150. doi: 10.19982/j.issn.1000-6621.20230284

Zhang Yan, Wang Senlu, Rizwanguli Rehman, Liu Nianqiang, Wang Xinqi, Mao Hongkai, Wang Xiaomin, Cao Mingqin. Evaluation of the implementation effect of “Active Tuberculosis Screening+Full-Course Hospitalization” model for patient detection in Hotan Prefecture, Xinjiang Uygur Autonomous Region[J]. Chinese Journal of Antituberculosis, 2024, 46(2): 145-150. doi: 10.19982/j.issn.1000-6621.20230284

图/表 5

表1

表2

图1

表3

图2

参考文献 17

[1]	王明哲, 王乐, 祖丽呼玛尔·艾尔肯, 等. 2011—2020年新疆普通肺结核患者流行病学特征分析. 预防医学情报杂志, 2022, 38(10): 1334-1339,1345.
[2]	中华人民共和国国务院办公厅. 国务院办公厅关于印发全国结核病防治规划(2011—2015)的通知. 国办发〔2011〕53号. 2011-11-17.
[3]	王新旗, 依帕尔·艾海提, 王森路, 等. 新疆结核病防治模式初探及展望. 疾病预防控制通报, 2022, 37(2): 11-16. doi:10.13215/j.cnki.jbyfkztb.2112021.
[4]	Anglin KL, Wong VC, Wing C, et al. The validity of causal claims with repeated measures designs: A within-study comparison evaluation of differences-in-differences and the comparative interrupted time series. Eval Rev, 2023, 47(5): 895-931. doi:10.1177/0193841X231167672.
[5]	Degli Esposti M, Spreckelsen T, Gasparrini A, et al. Can synthetic controls improve causal inference in interrupted time series evaluations of public health interventions?. Int J Epidemiol, 2021, 49(6): 2010-2020. doi:10.1093/ije/dyaa152. URL pmid: 33005920
[6]	李洋, 于石成, 金承刚, 等. 两组中断时间序列设计及其分析方法. 中华流行病学杂志, 2019, 40(9): 1159-1163. doi:10.3760/cma.j.issn.0254-6450.2019.09.027.
[7]	李辉章, 杜灵彬. Joinpoint回归模型在肿瘤流行病学时间趋势分析中的应用. 中华预防医学杂志, 2020, 54(8): 908-912. doi:10.3760/cma.j.cn112150-20200616-00889.
[8]	Lopez Bernal J, Cummins S, Gasparrini A. The use of controls in interrupted time series studies of public health interventions. Int J Epidemiol, 2018, 47(6): 2082-2093. doi:10.1093/ije/dyy135. URL pmid: 29982445
[9]	王明哲, 刘年强, 凯德丽艳·阿布都外力, 等. 主动发现对南疆四地州肺结核疫情的影响. 中国防痨杂志, 2022, 44(5): 460-466. doi:10.19982/j.issn.1000-6621.20210725.
[10]	毛宏凯, 张燕, 梁智超, 等. 基于合成控制法的南疆肺结核防控策略实施效果评价. 中国防痨杂志, 2023, 45(4): 383-390. doi:10.19982/j.issn.1000-6621.20220509.
[11]	Burke RM, Nliwasa M, Feasey HRA, et al. Community-based active case-finding interventions for tuberculosis: a systematic review. Lancet Public Health, 2021, 6(5): e283-e299. doi:10.1016/S2468-2667(21)00033-5. URL pmid: 33765456
[12]	麦维兰江·阿不力米提, 地尔木拉提·吐孙, 克尤木·吾布力喀斯木, 等. 新疆喀什地区初治肺结核患者成功治疗后复发影响因素分析. 中国防痨杂志, 2022, 44(11): 1148-1153. doi:10.19982/j.issn.1000-6621.20220299.
[13]	周林, 刘二勇. “早诊断及规范治疗肺结核患者”是落实最新国家行业标准及技术规范的精髓. 中国防痨杂志, 2020, 42(9): 894-895. doi:10.3969/j.issn.1000-6621.2020.09.002.
[14]	彭城, 项莉. 武汉市初治涂阳肺结核患者规范化隔离治疗住院费用及治疗效果分析. 医学与社会, 2020, 33(6): 69-72. doi:10.13723/j.yxysh.2020.06.017.
[15]	McQuaid CF, Vassall A, Cohen T, et al. The impact of COVID-19 on TB: a review of the data. Int J Tuberc Lung Dis, 2021, 25(6): 436-446. doi:10.5588/ijtld.21.0148. URL pmid: 34049605
[16]	Yuen CM, Amanullah F, Dharmadhikari A, et al. Turning off the tap: stopping tuberculosis transmission through active case-finding and prompt effective treatment. Lancet, 2015, 386(10010): 2334-2343. doi:10.1016/S0140-6736(15)00322-0. URL pmid: 26515675
[17]	Chakaya JM, Harries AD, Marks GB.Ending tuberculosis by 2030-Pipe dream or reality?. Int J Infect Dis, 2020, 92S: S51-S54. doi:10.1016/j.ijid.2020.02.021. URL pmid: 32114202

年份	报告发病 (例)	人口数 (万)	报告发病率 (/10万)
2012	4287	203.03	211.15
2013	4969	203.92	243.68
2014	5620	205.69	273.22
2015	5084	208.71	243.59
2016	5386	214.63	250.94
2017	6672	217.00	307.47
2018	10278	220.99	465.10
2019	6373	229.08	278.20
2020	4516	227.19	198.77
2021	3241	250.47	129.40

指标	回归系数(95%CI)	标准误	t值	P值
β₀	16.373(10.349~22.396)	3.041	5.38	<0.001
β₁	0.112(-0.023~0.247)	0.068	1.65	0.102
β₂	16.859(6.720~26.998)	5.119	3.29	0.001
β₃	-1.098(-1.465~-0.731)	0.185	-5.93	<0.001

指标	回归系数(95%CI)	标准误	t值	P值
β₀	6.151(5.274~7.029)	0.447	13.760	<0.001
β₁	0.004(-0.015~0.024)	0.010	0.420	0.677
β₂	1.154(-0.285~2.593)	0.734	1.570	0.116
β₃	-0.149(-0.202~-0.096)	0.027	-5.520	<0.001
β₄	9.933(7.024~12.842)	1.483	6.700	<0.001
β₅	0.117(0.052~0.181)	0.033	3.520	<0.001
β₆	14.751(9.978~19.524)	2.433	6.060	<0.001
β₇	-0.931(-1.107~-0.755)	0.090	-10.380	<0.001

新疆维吾尔自治区和田地区“肺结核主动筛查+全疗程住院治疗”模式对患者发现的效果

Evaluation of the implementation effect of “Active Tuberculosis Screening+Full-Course Hospitalization” model for patient detection in Hotan Prefecture, Xinjiang Uygur Autonomous Region

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 5

参考文献 17

相关文章 15

编辑推荐

Metrics

本文评价

友情链接

[1]	王莉燕, 周慧, 吴倩, 郝晓刚, 陆冰欣, 陈彬. 浙江省龙游县肺结核诊疗“零负担”策略实施效果评估[J]. 中国防痨杂志, 2024, 46(4): 418-423.
[2]	王森路, 刘年强, 王新旗, 曹明芹, 王乐, 王希江. 结核病防治“新疆模式”的发展及成效[J]. 中国防痨杂志, 2024, 46(2): 141-144.
[3]	包亮亮, 王新旗, 张燕, 曹明芹. 新疆维吾尔自治区南疆地区结核病防治工作实施现状的定性评价——基于扎根理论的质性访谈[J]. 中国防痨杂志, 2024, 46(2): 151-157.
[4]	郑光敏, 王挺, 张丹妮, 雷宇, 杨洁莹, 吴桂锋, 杜雨华, 肖新才. “十三五”期间广州市不同结核病防治管理模式实施效果评价[J]. 中国防痨杂志, 2024, 46(2): 199-205.
[5]	李改云, 吴杨昊天, 丁明峰, 李懿伦, 张嘉文, 罗晓蕾, 江靖雯, 韩雪梅. 取消药品加成政策前后肺结核患者住院费用的中断时间序列分析[J]. 中国防痨杂志, 2022, 44(10): 1071-1078.
[6]	范君, 张文, 张婷, 汪清雅, 余雅, 成君. 2008—2019年重庆市学生肺结核报告发病特征分析[J]. 中国防痨杂志, 2021, 43(7): 716-723.
[7]	黄烈雨, 王溪, 陈浩, 黄若尧, 左玲, 郭岩. 基于网络爬虫的英国政府网站结核病主题政策发文计量分析[J]. 中国防痨杂志, 2021, 43(11): 1199-1209.
[8]	应若嫣, 黄晓辰, 王洁, 刘一典, 沙巍, 杨华. 首次复治肺结核患者对治疗方案药品敏感性与治疗转归的相关性分析[J]. 中国防痨杂志, 2021, 43(10): 1001-1005.
[9]	周林, 刘二勇, 孟庆琳, 陈明亭, 周新华, 高微微, 林明贵, 谢汝明. 《WS 288—2017 肺结核诊断》标准实施后肺结核诊断质量评估分析[J]. 中国防痨杂志, 2020, 42(9): 910-915.
[10]	孟庆琳, 李进岚, 林定文, 马永成, 侯双翼, 刘年强, 周林. 结核病防治从业人员对新的结核病标准相关知识知晓情况调查分析[J]. 中国防痨杂志, 2020, 42(9): 921-925.
[11]	李婷, 何金戈, 苏茜, 李京, 李运葵, 高文凤, 高媛, 杨文. 结核菌素试验在四川省布拖县HIV感染/AIDS患者中筛查结核感染的价值[J]. 中国防痨杂志, 2020, 42(9): 931-936.
[12]	董晓, 赵珍, 刘年强, 王森路, 崔燕. 2009—2017年新疆维吾尔自治区老年肺结核发现特征分析[J]. 中国防痨杂志, 2020, 42(9): 956-961.
[13]	李晓坤, 袁燕莉, 杨光旭, 武媛媛. 《长春市结核病定点医院信息化管理平台》的设计与应用[J]. 中国防痨杂志, 2020, 42(7): 671-675.
[14]	刘广天, 刘涛, 王晓炜, 雷娟, 田晓梅, 王晓林. 宁夏地区“互联网+医疗”模式在结核病防治工作中的应用[J]. 中国防痨杂志, 2020, 42(7): 676-681.
[15]	包训迪, 江跃, 梁锁, 程红燕, 夏广秀, 王超, 叶倩, 王舒, 王庆. 安徽省非结核分枝杆菌临床分离率及人群分布和耐药性分析[J]. 中国防痨杂志, 2020, 42(7): 718-724.