关键词: 结核,肺, 死亡原因, 危险因素, 因素分析,统计学, 小地区分析

Abstract:

Objective To explore the risk factors of death in tuberculosis patients and to provide a scientific reference for reducing the mortality of tuberculosis patients. Methods According to the Tuberculosis Information Management System of Chinese Center for Disease Control and Prevention, 782 patients with active tuberculosis were registered and diagnosed in Songjiang District of Shanghai from January 1, 2004 to December 31, 2008. A total of 765 patients were included in the study, excluding rural areas, floating population and patients who lost their visits. The end point of this study was June 1, 2019, with an average follow-up time of (9.7±3.2) years. A retrospective cohort study was used to collect basic demographic information, survival time and survival status of patients. Risk factors of all-cause death of tuberculosis patients and TB-caused deaths were analyzed by Cox proportional hazard regression model. P<0.05 was considered statistically significant. Results From 2004 to 2008, 32 cases died of tuberculosis, with a mortality rate of 4.2%. Two hundred and thirty-three cases died of all causes, with a mortality rate of 30.5%. The mortality rate of all causes and TB-caused deaths in the first year after diagnosis were the highest ( {\chi }_{\mathrm{trend}}^2 =20.16 and 3.00,respectively, P values were all <0.05). Cox multivariate analysis showed that the risk factors of patients who died from all causes of death were male (aHR=0.12, 95%CI=0.03-0.77), 41-60 years old group (aHR=1.52, 95%CI=1.23-1.88), ≥61 years old group (aHR=1.60, 95%CI=1.37-1.73), lung cavity (aHR=2.12, 95%CI=1.57-2.83), sputum smear positive (aHR=1.76, 95%CI=1.52-1.91) and other underlying diseases (diabetes: aHR=1.35,95%CI=1.26-1.47;tumor: aHR=1.78,95%CI=1.48-1.96). The risk factors of death due to tuberculosis included age which over 61 years old (aHR=1.34, 95%CI=0.08-1.85), lung cavity (aHR=2.95, 95%CI=1.26-6.71), retreatment (aHR=1.43, 95%CI=0.18-1.85), sputum smear positive (aHR=1.17, 95%CI=0.48-2.15), multidrug-resistant tuberculosis (aHR=1.20, 95%CI=1.01-1.56), and other underlying diseases (diabetes: aHR=1.23, 95%CI=1.04-1.25; tumor: aHR=13.72, 95%CI=1.78-95.75). Conclusion Medical and health institutions should pay attention to the influence factors such as age over 40 years old, male, lung cavity, sputum smear positive, diabetes and tumor on all causes of death in patients with tuberculosis, and age over 61 years old, lung cavity, retreatment, sputum smear positive, MDR-TB, diabetes and tumor on death due to tuberculosis. Special attention should be paid to the treatment after the first year of diagnosis to reduce the risk of death.

Key words: Tuberculosis,pulmonary, Cause of death, Risk factors, Factor analysis,statistical, Small-area analysis