关键词: 结核,肺, 老年人, 流行病学研究特征(主题), 对比研究, 小地区分析

Abstract:

Objective To explore the epidemic characteristics of elderly (≥60 years old) and non-elderly (<60 years old) pulmonary tuberculosis patients in Jing’an District, Shanghai, providing reference for the prevention and treatment of tuberculosis in the elderly. Methods Data of the tuberculosis patients first managed and registered in Jing’an District from April 1, 2014 to March 31, 2019 were collected from China Information System for Disease Control and Prevention (subsystem “TB Management Information System”), including the medical records, diagnosis and treatment information, 0-month laboratory and imaging examination results, treatment effect and prognosis.These data were divided into ≥60 years old group and <60 years old group, and the characteristics of pulmonary tuberculosis patients in the two groups were compared and analyzed. Results From April 1, 2014 to March 31, 2019, a total of 1563 pulmonary tuberculosis patients in the whole population were registered, of whom 555 patients (35.51%) were ≥60 years old, and the composition ratio increased from 27.62% (95/344) to 41.30% (114/276) in the past five years, showing an increasing trend (χ²=7.501, P=0.006). Of the patients ≥60 years old, the local household registration (95.86% (532/555)) and male (74.59% (414/555)) of the patients were significantly higher than those in the <60 years old group (61.71% (622/1008), 68.35% (689/1008)) (χ ²=2.160, 6.713; P=0.000, 0.010). Most pulmonary tuberculosis patients of the two groups in Jing’an District were passively screened through symptom visits (67.21% (373/555) vs. 69.35% (699/1008)) and referrals (30.27% (168/555) vs. 28.37% (286/1008)). The complication rate of other diseases, positive etiological test, re-treatment, positive rate of 0-month sequence sputum smear and abnormal rate of chest film in the ≥60 years old group were all higher than those in the <60 years old group (26.13% (145/555) vs. 14.19% (143/1008), χ ²=33.946, P=0.000; 46.67% (259/555) vs. 35.32% (356/1008), χ ²=19.318, P=0.000; 14.59% (81/555) vs. 9.23% (93/1008), χ ²=10.427, P=0.001; 41.62% (231/555) vs. 25.69% (259/1008), χ ²=42.189, P=0.000; 99.10% (550/555) vs. 96.73% (975/1008), χ ²=8.496, P=0.004; respectively). The negative conversion rate of sputum smear at the end of the 2nd month and the cure or completion of treatment of patients aged ≥60 years were both lower than those of patients aged <60 years (73.59% (170/231) vs. 85.33% (221/259), χ ²=10.430, P=0.001; 80.18% (445/555) vs. 92.86% (936/1008), χ ²=57.199, P=0.000; respectively). Conclusion The registered tuberculosis patients in the whole population decreased year by year in Jing’an District, however, the proportion of the elderly patients increased year by year. The male elderly population with local household registration and complicated diseases should be paid more attention. Considering the high positive rates of sputum bacteria test and chest X-ray, and poor treatment effect of the elderly population, active screening and standard treatment should be carried out.

Key words: Tuberculosis,pulmonary, The elderly, Epidemiologic study characteristics as topic, Comparative study, Small-area analysis