Cross-sectional study on the health examination and KAP of tuberculosis for the aged group in nursing home in Shanghai

doi:10.3969/j.issn.1000-6621.2019.03.014

Abstract

Abstract:

Objective To describe the health examination and social care received by the aged group, as well as their KAP to tuberculosis (TB), in nursing home in Shanghai.Methods From Sep. to Dec. 2017, Twenty-one nursing homes were sampled, which located in three urban districts and four suburb districts (three from each district) in Shanghai. Four hundred and thirty-eight people aged over 60 years old, who were healthy enough and willing to be investigated, were sampled from selected nursing homes. Their demographics and health situation, as well as KAP of TB were analyzed and comparisons were carried out between nursing home of urban and suburb districts.Results Totally 438 aged persons were investigated, among which, 36.8% (161/438) were male and 75.8% (332/438) were over 80 years old. 92.7% (406/438) of them were Shanghai residents and 90.9% (398/438) had education background of middle school or even lower degree. 56.8% (249/438) of them had stayed in the nursing home longer than 1 year but shorter than 5 years. 88.6% (388/438) of them had chronic disease and 50.9% (223/438) had at least two kinds of chronic diseases. 82.9% (363/438) of the aged received chest X-ray test before entering nursing home but 28.3% (124/438) were not tested after entering the nursing home. Higher proportion of the aged receiving chest X-ray test were found in urban areas than in suburban areas, both before (93.2% (179/192) vs 74.8% (184/246), χ ²=25.82, P<0.001) and after (88.0% (169/192) vs 58.9% (145/246), χ ²=44.92, P<0.001) entering nursing home. 35.4% (155/438) of the old people were visited once a week or less frequently, more visiting were found in urban areas than in suburban areas (78.6% (151/192) vs 53.7% (132/246), χ ²=29.45, P<0.001). 70.3% (308/438) of the old people never left the nursing home within one year. The proportions of the old people who knew that TB was infectious and that it was an airborne disease were 86.1% (309/359) and 72.5% (224/309) respectively. Only 29.0% (104/359) of the aged knew that anyone who had chronic cough for more than two weeks should be suspected as TB patient.Conclusion Collaboration between nursing home and health facilities need to be established and improved to provide timely health examination for the aged group. Health education about TB knowledge and social care should also be strengthened for the aged group in nursing home.

Key words: Tuberculosis, pulmonary, Aged, Homes for the aged, Cognition, Questionnaires, Outcome assessment (health care)

Jing CHEN,Li-xin RAO,Ying-qing NI,Kai-kan GU,Yi-hui ZHENG,Xiao-feng LIU,Li-hong TANG,Peng LI,Chun-hua XU,Xin SHEN. Cross-sectional study on the health examination and KAP of tuberculosis for the aged group in nursing home in Shanghai[J]. Chinese Journal of Antituberculosis, 2019, 41(3): 322-329. doi: 10.3969/j.issn.1000-6621.2019.03.014

Figures/Tables 5

References 16

[1]	全国第五次结核病流行病学抽样调查技术指导组, 全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告. 中国防痨杂志, 2012,34(8):485-508.
[2]	李亮, 唐俊舫, 端木宏谨 , 等. 我国老年结核病流行现状分析. 中华医学杂志, 2006,86(37):2646-2648. doi: 10.3760/j:issn:0376-2491.2006.37.014 URL
[3]	刘英, 胡代玉, 靖宽和 , 等. 老年肺结核病就诊和诊断延迟情况分析. 现代预防医学, 2007,34(9):1665-1669. doi: 10.3969/j.issn.1003-8507.2007.09.022 URL
[4]	上海市统计局, 国家统计局上海调查总队. 2017上海统计年鉴. 北京: 中国统计出版社, 2017.
[5]	上海市民政局,上海市老龄工作委员会办公室,上海市统计局. 2016年上海市老年人口和老龄事业监测统计信息[EB/OL]. 上海:上海市老龄科学研究中心,2017( 2017- 03- 21)[2018-08-27]. .
[6]	上海市民政局. 上海市养老机构一览表[EB/OL]. 上海:上海市民政局,2018( 2018- 06- 01)[2018-08-27]. .
[7]	中华人民共和国国家卫生计生委办公厅, 中华人民共和国国家发展改革委办公厅, 中华人民共和国财政部办公厅. 关于开展全国结核病防治规划(2011—2015年)终期评估的通知. 国卫办疾控函〔2015〕674号. 2015-07-31.
[8]	上海市人民政府. 市政府关于印发《上海市老龄事业发展“十三五”规划》的通知. 沪府发〔2016〕85号. 2016-09-30.
[9]	Shen X, Deriemer K, Yuan Z , et al. Deaths among tuberculosis cases in Shanghai, China: who is at risk? BMC Infect Dis, 2009,9:95. doi: 10.1186/1471-2334-9-95 URL pmid: 2702371
[10]	陈勇, 沈鑫, 潘启超 , 等. 上海市1999—2006年新登记老年肺结核患者死亡情况及影响因素分析. 中国防痨杂志, 2012,34(12):784-789.
[11]	应杰, 胡跃强, 叶晓东 , 等. 一起敬老院聚集性肺结核疫情的流行病学调查. 现代预防医学, 2015,42(6):982-983.
[12]	Seto J, Wada T, Suzuki Y , et al. Mycobacterium tuberculosis transmission among elderly persons, Yamagata Prefecture, Japan, 2009-2015. Emerg Infect Dis, 2017,23(3):448-455. doi: 10.3201/eid2303.161571 URL pmid: 5382749
[13]	中华人民共和国国务院办公厅. “十三五”全国结核病防治规划. 国办发〔2017〕16号. 2017-02-01.
[14]	上海市人民政府. “十三五”上海市结核病防治规划. 沪府办发〔2017〕71号. 2017-11-08.
[15]	姜世闻 . 重视老年人结核病防治工作. 结核病与肺部健康杂志, 2018,7(3):157-160. doi: 10.3969/j.issn.2095-3755.2018.03.002 URL
[16]	陆伟 . 直面老龄化趋势重视老年肺结核. 结核病与肺部健康杂志, 2018,7(3):153-156. doi: 10.3969/j.issn.2095-3755.2018.03.001 URL

基本情况	城区(192名)				郊区(246名)		合计(438名)
基本情况	人数(名)		构成比(%)		人数(名)	构成比(%)	人数(名)	构成比(%)
年龄组(岁)
60~	8		4.2		29	11.8	37	8.4
70~	19		9.9		50	20.3	69	15.8
80~	106		55.2		139	56.5	245	55.9
≥90	59		30.7		28	11.4	87	19.9
性别
男	76		39.6		85	34.6	161	36.8
女	116		60.4		161	65.4	277	63.2
户籍
上海	174		90.6		232	94.3	406	92.7
非上海	18		9.4		14	5.7	32	7.3
学历
小学及以下	91		47.4		151	61.4	242	55.3
中学	81		42.2		75	30.5	156	35.6
大专及以上	20		10.4		20	8.1	40	9.1
基本情况		城区(192名)			郊区(246名)		合计(438名)
基本情况		人数(名)		构成比(%)	人数(名)	构成比(%)	人数(名)	构成比(%)
婚姻状况
在婚		33		17.2	51	20.7	84	19.2
未婚/离异		12		6.2	22	9.0	34	7.8
丧偶		147		76.6	173	70.3	320	73.0
职业
工人		92		47.9	66	26.8	158	36.1
农民		18		9.4	80	32.5	98	22.4
行政、医务人员、教师		37		19.3	47	19.1	84	19.2
其他专业技术人员^a		29		15.1	25	10.2	54	12.3
商业服务业人员		16		8.3	28	11.4	44	10.0
入住养老机构时长(年)
<1		40		20.8	42	17.1	82	18.7
1~		112		58.4	137	55.7	249	56.8
6~		33		17.2	47	19.1	80	18.3
>10		7		3.6	20	8.1	27	6.2

健康状况	城区(192名)		郊区(246名)		合计(438名)
健康状况	人数(名)	构成比(%)	人数(名)	构成比(%)	人数(名)	构成比(%)
结核病病史
有	10	5.2	22	8.9	32	7.3
无	182	94.8	224	91.1	406	92.7
高血压
有	108	56.3	139	56.5	247	56.4
无	84	43.7	107	43.5	191	43.6
糖尿病
有	48	25.0	56	22.8	104	23.7
无	144	75.0	190	77.2	334	76.3
心脏病
有	44	22.9	55	22.4	99	22.6
无	148	77.1	191	77.6	339	77.4
白内障
有	42	21.9	56	22.8	98	22.4
无	150	78.1	190	77.2	340	77.6
脑卒中
有	37	19.3	28	11.4	65	14.8
无	155	80.7	218	88.6	373	85.2
关节炎
有	32	16.7	25	10.2	57	13.0
无	160	83.3	221	89.8	381	87.0
慢性阻塞性肺疾病
有	19	9.9	20	8.1	39	8.9
无	173	90.1	226	91.9	399	91.1
肿瘤
有	8	4.2	5	2.0	13	3.0
无	184	95.8	241	98.0	425	97.0
近2周咳嗽
有	29	15.1	20	8.1	49	11.2
无	163	84.9	226	91.9	389	88.8
近2周咳痰
有	17	8.9	8	3.3	25	5.7
无	175	91.1	238	96.7	413	94.3

检查情况	城区(192名)		郊区(246名)		合计(438名)		χ²值	P值
检查情况	人数(名)	构成比(%)	人数(名)	构成比(%)	人数(名)	构成比(%)	χ²值	P值
入住前胸片检查							25.82	<0.001
有	179	93.2	184	74.8	363	82.9
无	13	6.8	62	25.2	75	17.1
入住前胸片检查地点^a							36.08	<0.001
本养老机构内	12	6.7	3	1.6	15	4.1
综合医院	131	73.2	104	56.5	235	64.7
社区卫生服务中心	20	11.2	68	37.0	88	24.3
体检中心	16	8.9	9	4.9	25	6.9
入住后胸片检查							44.92	<0.001
有	169	88.0	145	58.9	314	71.7
无	23	12.0	101	41.1	124	28.3
入住后最近一次胸片检查时间^b							39.25	<0.001
≤1年	66	43.4	72	35.3	138	38.8
>1年	52	34.2	31	15.2	83	23.3
未检查	15	9.9	18	8.8	33	9.3
记不清	19	12.5	83	40.7	102	28.6
入住后最近一次胸片检查地点^c							40.03	<0.001
本养老机构内	15	8.8	4	2.8	19	6.1
综合医院	125	74.0	71	49.0	196	62.4
社区卫生服务中心	17	10.1	55	37.9	72	22.9
体检中心	12	7.1	15	10.3	27	8.6

社会家庭关怀情况	城区(192名)		郊区(246名)		合计(438名)		χ²值	P值
社会家庭关怀情况	人数(名)	构成比(%)	人数(名)	构成比(%)	人数(名)	构成比(%)	χ²值	P值
家属探望频率(次/周)							29.45	<0.001
≥1	151	78.6	132	53.7	283	64.6
<1	41	21.4	114	46.3	155	35.4
主要联系人							7.77	0.005
子女	180	93.8	210	85.4	390	89.0
其他^a	12	6.2	36	14.6	48	11.0
最近一年内外出							5.36	0.021
是	46	24.0	84	34.2	130	29.7
否	146	76.0	162	65.8	308	70.3
外出时长(d)							2.97	0.226
<1	12	26.1	29	34.5	41	31.5
1~	28	60.9	38	45.3	66	50.8
>7	6	13.0	17	20.2	23	17.7
外出住所							2.18	0.337
自己家	14	30.4	19	22.6	33	25.4
子女家	13	28.3	19	22.6	32	24.6
其他^b	19	41.3	46	54.8	65	50.0

结核病核心知识	城区(192名)		郊区(246名)		合计(438名)		χ²值	P值
结核病核心知识	人数(名)	构成比(%)	人数(名)	构成比(%)	人数(名)	构成比(%)	χ²值	P值
知道结核病							8.48	0.004
是	169	88.0	190	77.2	359	82.0
否	23	12.0	56	22.8	79	18.0
知晓肺结核症状——咳嗽^a							28.10	<0.001
是	137	81.1	104	54.7	241	67.1
否	32	18.9	86	45.3	118	32.9
知晓肺结核症状——咳痰^a							35.32	<0.001
是	110	65.1	64	33.7	174	48.5
否	59	34.9	126	66.3	185	51.5
知晓肺结核症状——咯血及痰中带血^a							41.31	<0.001
是	117	69.2	67	35.3	184	51.3
否	52	30.8	123	64.7	175	48.7
肺结核传染^a							10.36	0.001
是	156	92.3	153	80.5	309	86.1
否或不知道	13	7.7	37	19.5	50	13.9
肺结核能否通过咳嗽打喷嚏传染^b							34.84	<0.001
能	92	59.0	132	86.3	224	72.5
不一定	51	32.7	10	6.5	61	19.7
不知道或不能	13	8.3	11	7.2	24	7.8
疑似肺结核咳嗽时长^a							17.72	<0.001
不知道	79	46.7	120	63.2	199	55.4
<2周	40	23.7	16	8.4	56	15.6
≥2周	50	29.6	54	28.4	104	29.0
肺结核能否治愈^a							30.61	<0.001
不知道或不能	27	16.0	43	22.6	70	19.5
大部分能	70	41.4	37	19.5	107	29.8
能	72	42.6	110	57.9	182	50.7