2008—2022年福建省0~14岁儿童肺结核流行病学特征分析

doi:10.19982/j.issn.1000-6621.20240168

摘要/Abstract

摘要：

目的：分析福建省2008—2022年0~14岁儿童肺结核报告发病情况及流行特征,为制定儿童结核病防控策略提供依据。方法：从“全民健康保障信息化工程疾病预防控制信息系统”的子系统“监测报告管理系统”和“基本信息系统”收集2008—2022年福建省0~14岁儿童肺结核报告发病数据和人口数据,采用回顾性描述和Joinpoint回归模型分析疾病的三间分布、病原学检查等情况。结果：2008—2022年福建省共报告0~14岁儿童肺结核患者1430例,占全人群肺结核患者比例年均为0.46%(1430/307833),15年间儿童肺结核年均报告发病率为1.44/10万(1430/99435600),总体趋于稳定[全局平均年度变化百分比(AAPC)=-5.69%,t=-1.618,P=0.106]。10~14岁儿童肺结核年均报告发病率为3.20/10万(929/29051400),高于0~4岁和5~9岁儿童(χ²=887.195,P<0.001);0~4岁儿童肺结核报告发病率总体呈明显下降趋势(AAPC=-8.55%,t=-2.438,P=0.015),5~9岁和10~14岁儿童呈阶段性变化,分别在2010—2022年[分段年度变化百分比(APC)=3.28%,t=2.416,P=0.036]和2010—2019年(APC=7.57%,t=2.787,P=0.027)出现明显上升趋势。每年儿童肺结核报告发病无周期性变化。儿童肺结核患者中病原学阳性患者年均占35.24%(504/1430),每年病原学阳性所占比例呈上升趋势($\chi_{\text{趋势}}^2$=55.195,P<0.001)。儿童年均报告发病率最高和最低的地区分别为宁德市和龙岩市,差异有统计学意义(χ²=169.688,P<0.001);除莆田市(AAPC=-6.77%,t=-2.957,P=0.011)和南平市(AAPC=-5.67%,t=-2.195,P=0.047)的儿童报告发病率呈明显下降趋势外,其余地市变化趋势稳定。结论：2008—2022年福建省儿童肺结核报告发病率处于较低水平,整体趋势较为稳定,5~9岁和10~14岁儿童出现波段上升,宁德市发病率较高且下降趋势不明显,需重点关注。

关键词: 结核,肺, 儿童, 发病率, 流行病学研究, 回归分析

Abstract:

Objective: To analyze the incidence and epidemic characteristics of pulmonary tuberculosis (PTB) among children aged 0-14 from 2008 to 2022 in Fujian Province, and to provide evidence for the prevention and control strategy of childhood tuberculosis. Methods: The incidence data and population data of PTB among children aged 0-14 in Fujian Province from 2008 to 2022 were extracted from the National Health Security Information Project Disease Prevention and Control Information System-Surveillance Management System and Basic Information System. The disease distribution and etiological examination results were analyzed using retrospective description and Joinpoint regression model. Results: From 2008 to 2022, a total of 1430 PTB cases among children aged 0-14 were reported in Fujian Province, accounting for 0.46% of the overall PTB patients (1430/307833). The average annual reported incidence of PTB in children during the 15-year period was 1.44/100000 (1430/99435600), which was generally stable (AAPC=-5.69%,t=-1.618,P=0.106). The average annual reported incidence of PTB among children aged 10-14 was 3.20/100000 (929/29051400), which was higher than that among children aged 0-4 and 5-9 (χ²=887.195,P<0.001). The reported incidence of PTB among children aged 0-4 showed a significant downward trend (AAPC=-8.55%,t=-2.438,P=0.015). The reported incidence of tuberculosis among children aged 5-9 and 10-14 showed a phased change, showing a significant upward trend in 2010—2022 (APC=3.28%,t=2.416,P=0.036) and 2010—2019 (APC=7.57%,t=2.787, P=0.027), respectively. There was no monthly periodic change in the incidence of PTB in children reported within each year. The average etiologically positive rate in children with PTB was 35.24% (504/1430) which showed an increasing trend from year to year ($\chi_{\text{trend}}^2$=55.195,P<0.001). The highest and lowest annual reported incidence of PTB among children were in Ningde City and Longyan City, respectively, and the difference was statistically significant (χ²=169.688,P<0.001). Except for Putian City (AAPC=-6.77%,t=-2.957, P=0.011) and Nanping City (AAPC=-5.67%,t=-2.195,P=0.047), where the reported incidences showed significant downward trends, incidences in the rest of cities were stable. Conclusion: From 2008 to 2022, the reported incidence of PTB in children in Fujian Province was at a low level, relatively stable through years, with an increase among children aged 5-9 and 10-14 in recent years, while the incidence in Ningde City was higher and the downward trend was not obvious, which should be paid attention to.

Key words: Tuberculosis,pulmonary, Children, Incidence, Epidemiologic studies, Regression analysis

中图分类号:

R521
R211

杜永成, 林淑芳, 戴志松, 林建. 2008—2022年福建省0~14岁儿童肺结核流行病学特征分析[J]. 中国防痨杂志, 2024, 46(10): 1219-1226. doi: 10.19982/j.issn.1000-6621.20240168

Du Yongcheng, Lin Shufang, Dai Zhisong, Lin Jian. Analysis on the epidemiological characteristics of pulmonary tuberculosis among children aged 0-14 in Fujian Province from 2008 to 2022[J]. Chinese Journal of Antituberculosis, 2024, 46(10): 1219-1226. doi: 10.19982/j.issn.1000-6621.20240168

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年份	合计			0~4岁			5~9岁			10~14岁			全人群报告发病例数	儿童报告发病例数占全人群报告发病例数的比例(%)
年份	人口数 (万人)	报告发病总例数	报告发病率 (/10万)	人口数 (万人)	报告发病例数	报告发病率 (/10万)	人口数 (万人)	报告发病例数	报告发病率 (/10万)	人口数 (万人)	报告发病例数	报告发病率 (/10万)	全人群报告发病例数	儿童报告发病例数占全人群报告发病例数的比例(%)
2008	706.96	174	2.46	246.14	42	1.71	204.68	33	1.61	256.14	99	3.87	34573	0.50
2009	708.79	126	1.78	247.72	41	1.66	218.57	15	0.69	242.50	70	2.89	26646	0.47
2010	726.08	85	1.17	260.38	25	0.96	238.05	8	0.34	227.65	52	2.28	23500	0.36
2011	579.29	83	1.43	202.24	14	0.69	189.97	9	0.47	187.08	60	3.21	21277	0.39
2012	581.56	64	1.10	216.36	14	0.65	204.81	14	0.68	160.39	36	2.24	20564	0.31
2013	597.66	64	1.07	218.99	11	0.50	229.31	11	0.48	149.36	42	2.81	19221	0.33
2014	611.34	84	1.37	227.65	13	0.57	233.90	12	0.51	149.79	59	3.94	19306	0.44
2015	624.98	73	1.17	234.08	17	0.73	236.24	12	0.51	154.66	44	2.84	18510	0.39
2016	624.66	81	1.30	238.98	17	0.71	233.14	14	0.60	152.54	50	3.28	17739	0.46
2017	628.68	91	1.45	240.49	20	0.83	234.66	11	0.47	153.53	60	3.91	18070	0.50
2018	645.01	112	1.74	246.82	18	0.73	240.64	19	0.79	157.55	75	4.76	19585	0.57
2019	661.95	108	1.63	259.64	14	0.54	209.93	11	0.52	192.38	83	4.31	18601	0.58
2020	668.04	98	1.47	253.72	10	0.39	215.97	13	0.60	198.35	75	3.78	17542	0.56
2021	802.52	103	1.28	267.15	16	0.60	283.42	18	0.64	251.95	69	2.74	17037	0.60
2022	776.04	84	1.08	197.13	11	0.56	307.64	18	0.59	271.27	55	2.03	15662	0.54
合计	9943.56	1430	1.44	3557.49	283	0.80	3480.93	218	0.63	2905.14	929	3.20	307833	0.46
AAPC (95%CI, %)	-5.69 (-12.16~1.25)			-8.55 (-14.89~-1.74)			-5.68 (-11.80~0.87)			-4.17 (-12.44~4.88)			-		-
t值	-1.618			-2.438			-1.707			-0.925			-		-
P值	0.106			0.015			0.088			0.355			-		-

年龄	阶段一				阶段二				阶段三
年龄	年份	APC (95%CI,%)	t值	P值	年份	APC (95%CI,%)	t值	P值	年份	APC (95%CI,%)	t值	P值
0~4岁	2008— 2011	-29.28 (-49.75~ -0.47)	-2.259	0.047	2011— 2022	-1.91 (-6.32~ 2.72)	-0.931	0.374	-	-	-	-
5~9岁	2008— 2010	-45.27 (-66.91~ -9.45)	-2.668	0.024	2010— 2022	3.28 (0.25~ 6.40)	2.416	0.036	-	-	-	-
10~14岁	2008— 2010	-21.29 (-55.38~ 38.84)	-0.997	0.352	2010— 2019	7.57 (1.11~ 14.45)	2.787	0.027	2019— 2022	-22.75 (-41.83~ 2.61)	-2.150	0.069
合计	2008— 2010	-33.26 (-57.29~ 4.30)	-2.142	0.069	2010— 2019	3.86 (-1.08~ 9.05)	1.839	0.108	2019— 2022	-11.10 (-28.88~ 11.14)	-1.246	0.253

地区	阶段一				阶段二				阶段三
地区	年份	APC (95%CI,%)	t值	P值	年份	APC (95%CI,%)	t值	P值	年份	APC (95%CI,%)	t值	P值
福州市	2008— 2011	-30.02 (-42.07~ -15.47)	-4.469	0.003	2011— 2015	16.50 (-3.55~ -40.72)	1.912	0.097	2015— 2022	-4.22 (-8.94~ 0.74)	-2.020	0.083
漳州市	2008— 2011	-30.82 (-56.81~ -10.82)	-1.742	0.112	2011— 2022	3.61 (-2.77~ 10.40)	1.243	0.242	-	-	-	-
龙岩市	2008— 2011	-47.72 (-79.41~ 32.75)	-1.646	0.144	2011— 2018	26.95 (-7.36~ 73.96)	1.791	0.116	2018— 2022	-26.51 (-59.23~ 32.50)	-1.236	0.256
宁德市	2008— 2010	-42.51 (-71.42~ 15.62)	-1.765	0.108	2010— 2022	3.38 (-0.81~ 7.74)	1.791	0.104	-	-	-	-