Analysis on the characteristics of tuberculosis patients detected through active case finding in the elderly

doi:10.3969/j.issn.1000-6621.2021.06.006

Abstract

Abstract:

Objective To explore the characteristics of patients and detection rate by active screening of pulmonary tuberculosis in the elderly population in the pilot sites. Methods During 2013—2019, the basic information and tuberculosis (TB) screening were carried out four times among permanent residents over 65 years old in 12 towns or communities in 8 counties (Xinzhuang Town, Minhang District, Shanghai; Daoshu Town, Danyang County, Jiangsu Province; Qinghu Town, Jiangshan City, Quzhou City, Zhejiang Province; Donghuan Street, Panyu District, Guangzhou City, Guangdong Province; Zhangshi Town, Weishi County, Kaifeng City, He’nan Province; Anjia Town and Changbao Town, Wuchang County, Harbin City, Heilongjiang Province; Houba Town, Erlangmiao Town and Chonghua town, Jiangyou City, Mianyang City, Sichuan Province; Jiucheng Town, Haicheng Town, Pingguo County, Baise City, Guangxi Zhuang Autonomous Region), the prevalence of TB among elderly was obtained and the characteristics of patients and the trend of detection rate were compared. Results From 2018 to 2019, among the 36843 individuals, 23566 completed chest X-ray examination with the screening rate of 63.96%, and 82 patients were diagnosed. The PTB detection rate in the elderly was significantly higher in men (519.53/100000, 56/10779) than in women (203.44/100000, 26/12780) (χ²=16.843, P<0.01). The detection rate increased with age, from 275.70/100000 (65-74 years old group, 45/16322) to 542.01/100000 (85-113 years old group, 6/1107)(χ²_trend=7.385, P=0.007). The detection rate was higher in western regions (Guangxi and Sichuan, 657.50/100000 (66/10038)) compared to the counties located in middle and eastern regions of China. The detection rate of close contacts and previous TB patients was significantly higher (9547.74/100000 (19/199) and 1108.03/100000(4/361)) compared to that of non-close contacts and new cases, respectively. From 2013 to 2019, there were four times screenings conducted in the same pilot site, the bacteriology positive rate of sputum smear in elderly TB patients (31.43% (55/175), 21.15% (33/156), 35.29% (36/102), 12.20% (10/82)) decreased with the year (χ²_trend=7.290, P=0.007). The TB detection rate in the elderly was 650.49/100000 (175/26903), 618.07/100000 (156/25240), 474.79/100000 (102/21483) and 347.96/100000 (82/23566) respectively, which decreased year by year (χ²_trend=25.659, P<0.01). Conclusion After frequent active case finding in the same area, the TB detection rate in the elderly decreased significantly. It reflects high risk factors, frequency and screening method should be considered when an active screening policy is developed.

Key words: Tuberculosis,pulmonary, Active case finding, Aged, Disease attributes

CHEN Hui, SUN Yan-bo, SHEN Xin, ZHU Li-mei, WANG Xiao-meng, SUN Ding-yong, ZHOU Lin, LIN Ding-wen, CHEN Chuang, ZHANG Can-you, ZHANG Hui, WANG Li-xia, ZHAN Si-yan, CHENG Jun. Analysis on the characteristics of tuberculosis patients detected through active case finding in the elderly[J]. Chinese Journal of Antituberculosis, 2021, 43(6): 550-556. doi: 10.3969/j.issn.1000-6621.2021.06.006

Figures/Tables 4

患者特征	2013年 (175例)		2014年 (156例)		2015年 (102例)		2018—2019年 (82例)		$χ 趋势 2$ 值	P值
患者特征	患者数 (例)	构成比 (%)	患者数 (例)	构成比 (%)	患者数 (例)	构成比 (%)	患者数 (例)	构成比 (%)	$χ 趋势 2$ 值	P值
咳嗽、咳痰≥2周和(或)咯血或血痰									1.036	0.309
是	32	18.29	4	2.56	12	11.76	9	10.98
否	143	81.71	152	97.44	90	88.24	73	89.02
任一症状^a									3.789	0.052
是	37	21.14	14	8.97	12	11.76	24	29.27
否	138	78.86	142	91.03	90	88.24	58	70.73
痰细菌学									7.290	0.007
阳性	55	31.43	33	21.15	36	35.29	10	12.20
阴性	120	68.57	123	78.85	66	64.71	72	87.80
空洞									5.221	0.156
有	22	12.57	8^b	5.30	11	10.78	9	10.98
无	153	87.43	143^b	94.70	91	89.22	73	89.02
病变累及范围									0.359	0.549
1~2个肺野	102	58.29	90	57.69	60	58.82	56	68.29
3~4个肺野	51	29.14	39	25.00	29	28.43	16	19.51
5~6个肺野	20	11.43	17	10.90	11	10.79	8	9.76
未知	2	1.14	10	6.41	2	1.96	2	2.44
累及下肺野									1.041	0.308
是	64	36.57	42^c	28.38	37^d	36.63	23	28.05
否	111	63.43	106^c	71.62	64^d	63.37	59	71.95

年份	实检人数 (名)	菌阳肺结核		活动性肺结核
年份	实检人数 (名)	例数	检出率(/10万)	例数	检出率(/10万)
2013	26903	55	204.44	175	650.49
2014	25240	33	130.74	156	618.07
2015	21483	36	167.57	102	474.79
2018—2019	23566	10	42.43	82	347.96
$χ 趋势 2$ 值		21.733		25.659
P值		<0.01		<0.01

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特征	实际筛查(23566名)^a		应筛查(36843名)^b		χ²值	P值
特征	人数(名)	构成比(%)	人数(名)	构成比(%)	χ²值	P值
性别					0.371	0.542
男性	10779	45.75	16946	46.01
女性	12780	54.25	19888	53.99
年龄组(岁)					170.110	<0.01
65~74	16322	69.28	24680	67.00
75~84	6131	26.02	9452	25.66
85~113	1107	4.70	2702	7.34

特征	实际筛查人数 (23566名)	活动性肺结核患者例数 (82例)	活动性肺结核检出率 (/10万)	χ²值	P值
性别^a				16.843	<0.01
男性	10779	56	519.53
女性	12780	26	203.44
年龄组(岁)^b				7.385^c	0.007
65~74	16322	45	275.70
75~84	6131	31	505.63
85~113	1107	6	542.01
地区^d				53.098^c	<0.01
东部	9935	5	50.33
中部	3593	11	306.15
西部	10038	66	657.50
民族				142.967	<0.01
汉族	18944	23	121.41
少数民族	4622	59	1 276.50
文化程度				5.721	0.126
文盲或半文盲	8368	35	418.26
小学	10015	38	379.43
初中	2809	8	284.80
高中或中专	1715	1	58.31
其他^e	659	0	0.00
职业				2.810	0.245
农牧渔民	19386	76	392.04
离退人员	1713	5	291.89
家务及待业	1084	1	92.25
其他^f	1383	0	0.00
婚姻状况				3.551	0.169
未婚	282	1	354.61
已婚	19658	75	381.52
丧偶	3425	6	175.18
其他^g	201	0	0.00
糖尿病病史				0.237	0.626
有	2217	9	405.95
无	21349	73	341.94
既往结核病病史				4.085	0.043
有	361	4	1108.03
无	23205	78	336.13
活动性肺结核患者密切接触史				489.865	<0.01
有	199	19	9547.74
无	23367	63	269.61