Abstract:

Objective To investigate the incidence of pulmonary tuberculosis concurrent with extrapulmonary tuberculosis and its relationship with gender and age group. Methods Using observational research method, 360187 hospitalized tuberculosis patients’ gender, age and the involved position of tuberculosis were collected from hospital information management system (HIS) of 21 medical institutions in 15 provinces in China from January 1, 2011 to December 31, 2017 by investigators with unified training. The incidence of extrapulmonary tuberculosis and its relationship with gender and age were analyzed. Results Among 360187 patients with tuberculosis, 238910 (66.33%) were male, 121277 (33.67%) were female, and the median age (quartile) (M(Q₁,Q₃)) was 47 (28, 62) years old; 42987 (11.93%) cases were concurrent with extrapulmonary tuberculosis, the highest incidence was tuberculous meningitis (2.72% (9809 cases), followed by cervical lymph node tuberculosis (1.93% (6966 cases)), tuberculous peritonitis (1.59% (5733 cases)), tuberculous pericarditis (0.94% (3399 cases)) and intestinal tuberculosis (0.94% (3380 cases)) etc. The incidence of tuberculous meningitis, cervical lymph node tuberculosis, tuberculous peritonitis, tuberculous pericarditis, tuberculous polyserositis, lumbar tuberculosis, thoracic tuberculosis and chest wall tuberculosis in male tuberculosis patients were respectively 2.44% (5829 cases), 1.44% (3429 cases), 1.41% (3376 cases), 0.90% (2138 cases), 0.75% (1791 cases), 0.67% (1604 cases), 0.64% (1522 cases), 0.60% (1438 cases), and significantly lower than that of female (respectively 3.28% (3980 cases),2.92% (3537 cases),1.94% (2357 cases),1.04% (1261 cases),0.90% (1093 cases),0.79% (960 cases),0.76% (924 cases),0.66% (805 cases))(χ ²=215.235,930.541,144.480,18.061,23.272,16.442,18.585,4.976;Ps<0.05). The differences of incidences of tuberculous meningitis, cervical lymph node tuberculosis, tuberculous peritonitis, intestinal tuberculosis, tuberculous pericarditis, tuberculous polyserositis, lumbar tuberculosis, thoracic tuberculosis, chest wall tuberculosis and throat tuberculosis between different age (1- to ≥65 year) groups were statistically significant (χ ²=3870.549,2939.502, 1830.620, 673.372,115.428, 319.078, 52.512, 19.308, 439.177, 136.619;Ps<0.05). Except that the incidence of thoracic tuberculosis did not change with age ($\chi^{2}_{trend}$=0.814, P=0.367) and that of tuberculous pericarditis increased with increase of age ($\chi^{2}_{trend}$=62.087, P<0.001), the incidence of other tuberculosis decreased with increase of age (Ps<0.001).Multivariate logistic regression analysis showed that the risk of pulmonary tuberculosis concurrent with extrapulmonary tuberculosis in female was significantly higher than that in male (OR (95%CI): 1.325 (1.297-1.353)), and the risk of other age groups was higher than that in the age group ≥65 years old (1-,15-,25-, 35-, 45-, 55- years old; OR (95%CI)=4.995 (4.655-5.360), 2.481 (2.397-2.568), 2.053 (1.982-2.126), 1.683 (1.619-1.749), 1.276 (1.228-1.326), 1.109 (1.067-1.153).The risk of pulmonary tuberculosis concurrent with extrapulmonary tuberculosis decreased with increase of age after controlling the influence of gender (OR (95%CI)=0.817 (0.812-0.821)). Conclusion The common extrapulmonary tuberculosis concurrent with pulmonary tuberculosis are tuberculous meningitis, cervical lymph node tuberculosis, tuberculous peritonitis, tuberculous pericarditis and intestinal tuberculosis, and the risk of extrapulmonary tuberculosis in female is higher than that in male, and its trends decrease with the increase of age.

Key words: Tuberculosis, pulmonary, Tuberculosis, extra-pulmonary, Sex distribution, Age distribution, Factor analysis, statistical, Causality, Multicenter study