Study on the relationship between the implementation of pulmonary tuberculosis control objective and the social determinants in China

doi:10.3969/j.issn.1000-6621.2019.01.017

Abstract

Abstract:

Objective To estimate the difficulty of pulmonary tuberculosis prevention and control objective implementation in various parts of China (excluding Chinese Taipei, Hongkong China and Macao China) and analyze its related factors.Methods Based on the reported incidence data of PTB in provinces and related social and economic indicators (including per capita GDP, registered unemployment rate in cities and towns, forest coverage rate, rural population proportion, child dependency ratio, elderly dependency ratio, illiteracy ratio, sex ratio, number of beds in health care institutions per 1000 persons, number of medical technical personnel in health care institutions per 1000 persons, per capita water consumption) from 2004 to 2016, standardized incidence ratio was used to estimate the difficulty of PTB control objective implementation in different regions in China. The related factors were discussed by using multi-level random intercept model.Results Over time, the distance between the incidence of PTB and the planning goals in 28 areas of China has gradually narrowed (between 0.39 and 2.49, year 2016). The gap between the incidence of PTB and planning objectives in Xinjiang Uygur Autonomous Region (SIR=3.38, year 2016), Tibet Autonomous Region (SIR=2.89, year 2016), Qinghai Province (SIR=2.36, year 2016), Guizhou Province (SIR=2.49, year 2016) is still large. In space, the farther distance changed from generally to individually, and the overall performance was farther in the west than in the east. The results of multi-level random intercept model revealed that there was a correlation between the control objective and per capita GDP (β=-0.055, t=-6.74), forest cover rate between 17.70% and 38.40% (β=-0.035, t=-2.05), forest cover rate >38.40% (β=-0.059, t=-2.08), illiteracy ratio >8.14% (β=0.048, t=3.41), per capita water consumption >520.70 m ³/person (β=-0.060, t=-2.33), the proportion of rural population (β=0.112, t=6.57; all P<0.05). Conclusion The distance between incidence and control planning of PTB is shortened, although it is still difficult for individual regions to achieve the planning objectives. The distance of tuberculosis control objective is negatively correlated with per capita GDP, per capita water consumption and forest coverage, and positively correlated with the proportion of rural population and illiteracy.

Key words: Tuberculosis, pulmonary, Models, theoretical, Communicable disease control, Epidemiologic studies

Man-hui ZHANG,Jian-jun LIU,Hong-yan YAO,Qi-qi WANG,Jin-fang SUN,Shi-cheng YU,Hui ZHANG. Study on the relationship between the implementation of pulmonary tuberculosis control objective and the social determinants in China[J]. Chinese Journal of Antituberculosis, 2019, 41(1): 80-87. doi: 10.3969/j.issn.1000-6621.2019.01.017

Figures/Tables 6

省份	2004年	2005年	2006年	2007年	2008年	2009年	2010年	2011年	2012年	2013年	2014年	2015年	2016年
北京	0.86	1.05	0.95	0.95	1.04	0.83	0.77	0.75	0.75	0.66	0.62	0.59	0.57
天津	0.56	0.69	0.69	0.68	0.63	0.47	0.45	0.48	0.44	0.42	0.39	0.38	0.39
河北	1.03	1.10	1.28	1.27	1.29	1.14	1.05	0.98	0.95	0.90	0.87	0.84	0.83
山西	1.06	1.63	1.46	1.48	1.48	1.32	1.23	1.19	1.06	0.98	0.84	0.77	0.71
内蒙古	1.49	1.99	1.87	1.93	1.85	1.56	1.37	1.31	1.26	1.11	0.94	0.91	0.92
辽宁	0.97	0.99	1.09	1.13	1.23	1.10	1.08	1.26	1.27	1.08	1.03	0.97	0.94
吉林	1.53	1.79	1.69	1.61	1.65	1.58	1.53	1.45	1.27	1.15	1.10	1.04	0.93
黑龙江	1.86	2.26	2.16	2.10	2.05	1.89	1.77	1.66	1.63	1.64	1.61	1.61	1.47
上海	0.70	0.59	0.57	0.59	0.58	0.53	0.52	0.54	0.52	0.52	0.52	0.49	0.48
江苏	1.18	1.35	1.23	1.17	1.13	1.02	0.95	0.86	0.85	0.79	0.76	0.71	0.65
浙江	1.63	1.64	1.65	1.61	1.51	1.28	1.13	1.10	1.08	0.97	0.99	0.93	0.89
安徽	1.08	1.79	1.79	1.76	1.71	1.36	1.24	1.14	1.18	1.14	1.11	1.05	1.02
福建	1.55	1.80	1.73	1.67	1.70	1.31	1.11	1.01	0.96	0.90	0.88	0.84	0.80
江西	1.67	2.51	2.09	2.00	1.87	1.78	1.58	1.48	1.40	1.33	1.32	1.30	1.30
山东	0.62	0.85	0.83	0.88	0.89	0.83	0.77	0.70	0.69	0.67	0.65	0.60	0.56
河南	1.29	2.09	1.85	1.84	1.74	1.49	1.34	1.27	1.31	1.22	1.20	1.13	1.08
湖北	1.93	2.19	2.17	2.19	2.07	1.67	1.57	1.61	1.61	1.52	1.46	1.42	1.36
湖南	1.22	1.88	2.01	2.15	2.02	1.81	1.68	1.66	1.73	1.68	1.61	1.56	1.42
广东	1.26	1.77	1.84	1.95	1.95	1.92	1.73	1.57	1.46	1.36	1.41	1.36	1.30
广西	2.43	2.88	2.84	2.90	2.84	2.19	2.08	1.97	2.03	1.93	1.98	1.88	1.70
海南	2.34	2.54	2.87	2.88	2.76	2.04	2.07	2.03	2.01	1.78	1.81	1.87	1.60
重庆	2.85	2.88	2.60	2.62	2.57	1.88	1.73	1.71	1.64	1.60	1.51	1.44	1.41
四川	1.76	2.11	2.13	2.17	1.99	1.71	1.60	1.51	1.48	1.42	1.33	1.25	1.21
贵州	2.33	3.02	3.17	3.70	3.95	3.46	2.71	2.57	2.57	2.59	2.51	2.60	2.49
云南	1.05	1.39	1.35	1.39	1.35	1.18	1.10	1.15	1.18	1.12	1.08	1.03	1.06
西藏	1.39	1.85	1.83	1.87	1.39	2.93	2.18	2.40	2.49	2.68	2.83	2.56	2.89
陕西	1.83	2.03	1.82	1.80	1.80	1.45	1.30	1.25	1.20	1.13	1.04	1.02	1.00
甘肃	1.52	1.74	2.27	2.54	2.67	2.19	1.81	1.70	1.46	1.35	1.28	1.08	1.08
青海	1.44	1.83	1.71	1.88	1.80	1.91	1.64	1.72	2.03	1.96	1.85	2.13	2.36
宁夏	1.24	1.22	1.56	1.40	1.18	1.06	1.14	0.91	0.82	0.83	0.92	0.78	0.74
新疆	2.60	3.92	4.21	4.29	4.27	3.68	3.16	2.96	3.29	3.22	3.24	3.38	3.38
全国	1.43	1.82	1.80	1.83	1.79	1.55	1.40	1.34	1.32	1.25	1.22	1.17	1.13

变量	$x ˉ$ ±s	最小值	最大值
SIR	1.54±0.72	0.38	4.29
人均国民生产总值(元/人)	34 573.73±22 722.52	4 317.00	118 198.00
城镇登记失业率(%)	3.57±0.68	1.20	6.50
森林覆盖率(%)	30.00±17.79	2.90	66.00
乡村人口构成比(%)	0.49±0.15	0.10	0.79
少年儿童抚养比	23.94±7.02	9.64	44.65
老年人口抚养比	12.52±2.57	6.71	20.31
文盲比率(%)	7.98±7.09	1.46	45.65
性别比值(男∶女)	104.19±3.69	94.65	120.43
每千人医疗机构床位数(张)	3.88±1.26	1.57	7.55
每千人卫生技术人员数(名)	4.89±1.89	2.00	15.46
人均用水量(m³/人)	534.77±436.76	161.17	2 657.39

变量	参照组	估计值	s $x ˉ$	t值	P值
人均国民生产总值(元/人)	-^a	-0.144	0.007	-19.72	<0.001
乡村人口构成比(%)	-^a	0.147	0.008	19.30	<0.001
少年儿童抚养比	-^a	0.132	0.008	16.96	<0.001
老年人口抚养比	-^a	-0.053	0.010	-5.38	<0.001
城镇登记失业率(%)
3.40~3.90	≤3.40	-0.016	0.025	-0.65	0.517
>3.90	-^b	0.040	0.025	1.64	0.102
森林覆盖率(%)
17.70~38.40	≤17.70	0.058	0.024	2.38	0.018
>38.40	-^b	0.099	0.024	4.04	<0.001
文盲比率(%)
4.46~8.14	≤4.46	0.041	0.023	1.77	0.077
>8.14	-^b	0.179	0.023	7.69	<0.001
性别比值(男∶女)
102.59~105.39	≤102.59	0.086	0.025	3.49	<0.001
>105.39	-^b	0.049	0.025	1.97	0.049
每千人医疗机构床位数(张)
3.12~4.45	≤3.12	-0.128	0.022	-5.69	<0.001
>4.45	-^b	-0.219	0.022	-9.75	<0.001
每千人卫生技术人员数(名)
3.93~5.34	≤3.93	-0.086	0.022	-3.98	<0.001
>5.34	-^b	-0.251	0.022	-11.64	<0.001
人均用水量(m³/人)
317.87~520.70	≤317.87	0.082	0.024	3.37	<0.001
>520.70	-^b	0.119	0.024	4.88	<0.001

变量	估计值	s $x ˉ$	检验值	P值
固定部分
截距	0.141	0.034	t=4.18	<0.001
随机部分
$σ u 0 2$	0.033	0.009	Z=3.79	<0.001
$σ e 0 2$	0.009	0.001	Z=13.66	<0.001

变量	参照组	估计值^a	s $x ˉ$	检验值	P值
固定部分
截距		0.175	0.035	t=4.99	<0.001
人均国民生产总值(元/人)	-^b	-0.055	0.008	t=-6.74	<0.001
乡村人口构成比(%)	-^b	0.112	0.017	t=6.57	<0.001
文盲比率(%)
4.46~8.14	≤4.46	0.001	0.010	t=0.05	0.958
>8.14	-^c	0.048	0.014	t=3.41	<0.001
人均用水量(m³/人)
317.87~520.70	≤317.87	0.023	0.021	t=1.08	0.280
>520.70	-^c	-0.060	0.026	t=-2.33	0.020
森林覆盖率(%)
17.70~38.40	≤17.70	-0.035	0.017	t=-2.05	0.041
>38.40	-^c	-0.059	0.028	t=-2.08	0.038
随机部分
$σ u 0 2$		0.022	0.006	Z=3.58	<0.001
$σ e 0 2$		0.003	0.000^d	Z=12.99	<0.001

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