Abstract:

Objective To analyze the effect of active screening of tuberculosis (TB) among local people aged 65 or older in Songjiang District of Shanghai, and provide scientific basis for active detection strategies for the elderly TB patients in a low epidemic area. Methods The current status of active screening of TB in local elderly aged 65 or older were collected from physical examination data of local elderly aged 65 or older via the health management platform between April 1st and August 31st 2018 performed in 15 community health service centers. The medical record information of all local elderly aged 65 or older with active TB who registered from January 1st 2018 to August 31st 2019 were collected from Tuberculosis Information Management System and Infectious Diseases Reporting Information Management System, and then compared with the data of active screening this year to acquire the morbidity of TB within one year after screening. Moreover, the effect of active screening for TB among elderly population was evaluated by screening rate and detection rate. Results A total of 129008 local elderly aged 65 or older were registered in 2018 in Songjiang District. The total screening rate for active screening of TB in the elderly was 57.48% (74150/129008), with the highest screening rate in the 70-74 age group (65.51% (21446/32736)), and the lowest screening rate in the ≥85 age group (22.61% (3074/13596)). The rate of conducting X-ray screening was 98.31% (72899/74150), of which 5050 had chest X-ray abnormalities (6.93%, 5050/72899), including 3 cases diagnosed as new TB with the new detection rate of 4.12/100000 (3/72899), 3 registered TB patients under treatment, 524 cases (0.72%, 524/72899) with old TB, and 4520 cases (6.20%, 4520/72899) diagnosed as other abnormalities, such as pulmonary nodule, pulmonary infection, pleural thickening, patchy shadow and so on. A total of 57 local TB elderly aged 65 or older were registered in Songjiang in 2018, with the registration rate of 44.18/100000 (57/129008), among which, the patients over 85 years old had the highest registration rate (73.55/100000 (10/13596)); the passive discovery rate was significantly higher than active detection rate (41.86/100000 (54/129008) vs. 4.12/100000, χ²=24.00, P<0.001); the morbidity of patients who received active screening (21.58/100000 (16/74150)) was significantly lower than that of unscreened patients (74.74/100000 (41/54858)) (χ²=20.16, P<0.001). And 32 elderly cases who received active screening were diagnosed with active TB within a year after screening (13 of them registered in 2018 and 19 registered in 2019). Conclusion The detection rate of active screening for TB in the elderly is low in low epidemic area, but it has clinical significance for screening chest abnormalities. In addition, it can improve the awareness of diagnosis and treatment of TB in elderly people, and they will more timely receive diagnosis and treatment. TB screening can be carried out in combination with the project of elderly chronic disease management.

Key words: Tuberculosis,pulmonary, Aged, Population surveillance, Communicable disease control, Multiphasic screening, Incidence, Data interpretation,statistical