Analysis of the epidemiological characteristics and influencing factors of treatment outcomes in patients with pulmonary tuberculosis complicated by diabetes in Kashgar Prefecture, 2018—2023

doi:10.19982/j.issn.1000-6621.20250228

Abstract

Abstract:

Objective: To analyze the epidemiological characteristics of patients with pulmonary tuberculosis complicated by diabetes mellitus (PTB-DM) and the influencing factors of treatment outcomes in Kashgar Prefecture, Xinjiang Uygur Autonomous Region. Methods: Through the “Tuberculosis Management Information System” subsystem of the “China Disease Prevention and Control Information System”, data on pulmonary tuberculosis patients registered and treated in Kashgar Prefecture, Xinjiang Uygur Autonomous Region from 2018 to 2023 were collected. Descriptive analysis was employed to compare the characteristics of PTB-DM patients with those of non-diabetic pulmonary tuberculosis patients managed during the same period. Regression analysis was conducted to examine the factors influencing the treatment outcomes of PTB-DM patients. Results: From 2018 to 2023, a total of 82990 patients with active pulmonary tuberculosis were registered in Kashgar, including 81048 patients without diabetes and 1942 PTB-DM patients. The annual registration rate of pulmonary tuberculosis decreased from 806.70/100000 (32851 cases) in 2018 to 154.80/100000 (7150 cases) in 2023, showing a downward trend (APC=-33.10%, $χ t r e n d 2$ =45.320, P<0.05). However, the annual registration rate of PTB-DM had increased from 2.70/100000 (110 cases) in 2018 to 14.72/100000 (680 cases) in 2023, showing a year-on-year upward trend (APC=48.00%, $χ t r e n d 2$ =6.280, P<0.05). There were significant differences in the distribution of gender, age, nationality, occupation, source of patients, pathogenic detection results and other characteristics between PTB-DM group and non-combined diabetes group. Among 1942 PTB-DM patients, 1701 achieved successful treatment, with a success rate of 87.59%. In 81048 pulmonary tuberculosis patients without diabetes, 74896 achieved successful treatment, with a success rate of 92.41%. Multivariate logistic regression analysis of influencing factors on treatment outcomes in PTB-DM patients revealed that occupations as farmers (OR=2.101, 95%CI: 1.560-2.821), patients undergoing retreatment (OR=2.277, 95%CI: 1.812-2.861), 45-54 years old (OR=2.080, 95%CI: 1.161-3.750), 55-64 years old (OR=3.360, 95%CI:1.910-5.911), 65-74 years old (OR=4.891, 95%CI: 2.820-8.482), ≥75 years old (OR=8.202, 95%CI: 4.201-16.023), positive pathogen results (OR=1.484, 95%CI: 1.147-1.920), referral/follow-up patients (OR=1.534, 95%CI: 1.116-2.109; OR=1.898, 95%CI: 1.275-2.826) had a higher risk of developing adverse treatment outcomes; patients from Yecheng County and Yuepuhu County (OR=0.148, 95%CI: 0.031-0.710; OR=0.110, 95%CI: 0.019-0.625) had a lower risk of adverse treatment outcomes. Conclusion: The registration rate of PTB-DM patients in Kashgar Region has been increasing year by year. PTB-DM patients are mainly farmers, elderly people, pathogen positive, and retreated patients, and the main sources of patients are referral and tracking; these factors are also the main risk factors for adverse treatment outcomes.

Key words: Tuberculosis, pulmonary, Diabetes mellitus, Comorbidity, Disease attributes, Factor analysis, statistical

CLC Number:

R52
R587.1

Maiweilanjiang Abulimiti, Abudukelimu Tawakuli, Gulimina Abulimiti, Huang Fei. Analysis of the epidemiological characteristics and influencing factors of treatment outcomes in patients with pulmonary tuberculosis complicated by diabetes in Kashgar Prefecture, 2018—2023[J]. Chinese Journal of Antituberculosis, 2025, 47(12): 1573-1582. doi: 10.19982/j.issn.1000-6621.20250228

Figures/Tables 5

特征	肺结核 (例)	肺结核合并糖尿病		肺结核未合并糖尿病		χ²值	P值
特征	肺结核 (例)	登记数(例)	构成比(%)	登记数(例)	构成比(%)	χ²值	P值
性别						41.368	0.000
男性	42904	864	44.49	42040	51.87
女性	40086	1078	55.51	39008	48.13
年龄组(岁)						4.419	0.036
0~14	128	0	0.00	128	0.16
15~24	3832	6	0.31	3826	4.72
25~34	6091	29	1.49	6062	7.48
35~44	5660	89	4.58	5571	6.87
45~54	9347	284	14.62	9063	11.18
55~64	18545	619	31.87	17926	22.12
65~74	26452	670	34.50	25782	31.81
75~84	10892	212	10.92	10680	13.18
≥85	2043	33	1.71	2010	2.48
民族						42.051	0.000
维吾尔族	81582	1884	97.01	79698	98.33
汉族	1043	56	2.88	987	1.22
其他	365	2	0.11	363	0.45
职业						384.555	0.000
农民	71467	1553	79.97	69914	86.26
家务及待业	6273	189	9.73	6084	7.51
离退人员	1346	139	7.16	1207	1.49
教师生	1939	8	0.41	1931	2.38
干部职员	375	22	1.13	353	0.44
工人	166	6	0.31	160	0.20
其他	1424	25	1.29	1399	1.72
合并HIV感染						4.934	0.026
是	83	5	0.26	78	0.10
否	82907	1937	99.74	80970	99.90
就诊延迟(d)						34.672	0.000
<14	26682	780	40.16	25902	31.96
14~27	16857	430	22.14	16427	20.27
28~41	18034	285	14.68	17749	21.90
42~55	7774	128	6.59	7646	9.43
≥56	13643	319	16.43	13324	16.44
诊断延迟(d)						10.772	0.000
<21	72073	1759	90.58	70314	86.76
21~41	5701	98	5.05	5603	6.91
42~62	2991	35	1.80	2956	3.65
63~83	1373	19	0.97	1354	1.67
≥84	852	31	1.60	821	1.01
地区分布						6.659	0.000
喀什市	9541	484	24.92	9057	11.17
疏勒县	6385	163	8.39	6222	7.68
疏附县	5336	178	9.17	5158	6.36
英吉沙县	9302	107	5.51	9195	11.35
伽师县	5828	173	8.91	5655	6.98
岳普湖县	2556	54	2.78	2502	3.09
莎车县	18872	448	23.07	18424	22.73
泽普县	5590	150	7.72	5440	6.71
叶城县	9582	66	3.40	9516	11.73
麦盖提县	4123	34	1.75	4089	5.05
巴楚县	5803	84	4.33	5719	7.05
塔什库尔干县	162	1	0.05	161	0.20
患者来源						664.072	0.000
健康体检	50458	722	37.18	49736	61.37
转诊	17528	789	40.63	16739	20.65
追踪	5650	362	18.64	5288	6.52
因症就诊	6172	54	2.78	6118	7.55
推介	2320	14	0.72	2306	2.85
其他	862	1	0.05	861	1.06
治疗分类						4.561	0.033
初治	61462	1479	76.16	59983	74.01
复治	21528	463	23.84	21065	25.99
病原学结果						720.090	0.000
阳性	30799	1318	67.87	29481	36.37
阴性	50351	591	30.43	49760	61.40
无结果	1840	33	1.70	1807	2.23
治疗2个月末痰涂片阴转						286.208	0.000
是	29988	1293	98.10	28695	97.33
否	811	25	1.90	786	2.67
成功治疗						61.954	0.000
是	76597	1701	87.59	74896	92.41
否	6393	241	12.41	6152	7.59
合计	82990	1942	100.00	81048	100.00

特征	患者例数	成功治疗(1701例)		不良治疗结局(241例)		χ²值	P值
特征	患者例数	登记数(例)	构成比(%)	登记数(例)	构成比(%)	χ²值	P值
性别						2.229	0.136
男性	864	746	86.34	118	13.66
女性	1078	955	88.59	123	11.41
年龄组(岁)						0.085	0.771
0~14	0	0	0.00	0	0.00
15~24	6	5	5/6	1	1/6
25~34	29	26	89.66	3	10.34
35~44	89	78	87.64	11	12.36
45~54	284	251	88.38	33	11.62
55~64	619	559	90.31	60	9.69
65~74	670	587	87.61	83	12.39
75~84	212	167	78.77	45	21.23
≥85	33	28	84.85	5	15.15
民族						0.284	0.594
维吾尔族	1884	1650	87.58	234	12.42
汉族	56	49	87.50	7	12.50
其他	2	2	2/2	0	0/2
职业						103.483	0.000
农民	1553	1355	87.25	198	12.75
家务及待业	189	169	89.42	20	10.58
离退人员	139	124	89.21	15	10.79
教师生	3	2	2/3	1	1/3
干部职员	22	21	95.45	1	4.55
工人	6	5	5/6	1	1/6
其他	30	25	83.33	5	16.67
就诊延迟(d)						0.661	0.416
<14	781	687	87.96	94	12.04
14~27	430	378	87.91	52	12.09
28~41	285	246	86.32	39	13.68
42~55	128	113	88.28	15	11.72
≥56	318	277	87.11	41	12.89
诊断延迟(d)						1.231	0.267
<21	1759	1536	87.32	223	12.68
21~41	98	90	91.84	8	8.16
42~62	35	30	85.71	5	14.29
63~83	19	18	94.74	1	5.26
≥84	31	27	87.10	4	12.90
地区分布						4.498	0.036
喀什市	484	421	86.98	63	13.02
疏勒县	163	144	88.34	19	11.66
疏附县	177	154	87.01	23	12.99
英吉沙县	107	98	91.59	9	8.41
伽师县	172	152	88.37	20	11.63
岳普湖县	54	51	94.44	3	5.56
莎车县	448	385	85.94	63	14.06
泽普县	150	128	85.33	22	14.67
叶城县	66	64	96.97	2	3.03
麦盖提县	35	31	88.57	4	11.43
巴楚县	84	72	85.71	12	14.29
塔什库尔干县	2	1	1/2	1	1/2
患者来源						5.072	0.026
健康体检	723	652	90.18	71	9.82
转诊	789	681	86.31	108	13.69
追踪	362	311	85.91	51	14.09
因症就诊	54	46	85.19	8	14.81
推介	14	11	78.57	3	21.43
治疗分类						18.371	0.000
初治	1479	1322	89.38	157	10.62
复治	463	379	81.86	84	18.14
病原学结果						5.683	0.008
阳性	1318	1142	86.65	176	13.35
阴性	591	533	90.19	58	9.81
无结果	33	26	78.79	7	2.12
合并HIV感染						3.242	0.072
阳性	5	3	3/5	2	2/5
阴性	1937	1698	87.66	239	12.34
治疗2个月末痰涂片阴转						141.060	0.000
是	1293	1114	86.16	179	13.84
否	25	17	68.00	8	32.00

变量	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
农民	0.741	0.152	25.911	<0.001	2.101(1.560~2.821)
复治	0.230	0.117	49.640	<0.001	2.277(1.812~2.861)
年龄组(参照组35~44岁组)
45~54岁组	0.734	0.301	5.940	0.015	2.080(1.161~3.750)
55~64岁组	1.213	0.288	17.770	<0.001	3.360(1.910~5.911)
65~74岁组	1.587	0.281	31.880	<0.001	4.891(2.820~8.482)
≥75岁组	2.105	0.342	37.910	<0.001	8.202(4.201~16.023)
病原学阳性	0.395	0.132	8.946	0.003	1.484(1.147~1.920)
转诊	0.428	0.163	6.940	0.008	1.534(1.116~2.109)
追踪	0.641	0.203	9.957	0.002	1.898(1.275~2.826)
岳普湖县	-1.909	0.243	5.673	0.017	0.148(0.031~0.710)
叶城县	-2.204	0.884	6.215	0.013	0.110(0.019~0.625)

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年份	人口数 (万名)	肺结核		肺结核合并糖尿病
年份	人口数 (万名)	发病数 (例)	登记率 (/10万)	发病数 (例)	登记率 (/10万)	年度递增率 (%)	占肺结核的比例(%)
2018	407.23	32851	806.70	110	2.70		0.33
2019	423.99	17956	423.50	77	1.82	-32.59	0.43
2020	427.84	10713	250.40	188	4.13	126.92	1.75
2021	448.49	8490	189.30	451	10.06	143.58	5.31
2022	452.29	5830	128.90	436	9.64	-4.17	7.48
2023	461.87	7150	154.80	680	14.72	52.70	9.51
合计	2548.83	82990	325.60	1942	7.18		2.34

序号	变量	赋值
Y	治疗结局	治疗成功=0,不良治疗结局=1
X₁	性别	男=0,女=1
X₂	年龄	0~14岁=1,15~24岁=2,25~34岁=3,35~44岁=4,45~54岁=5,55~64岁=6,65~74岁=7,≥75岁=8
X₃	职业	农民=1,家政及待业=2,离退休人员=3,教师生=4,干部职员=5,工人=6,其他=7
X₄	治疗分类	初治=0,复治=1
X₅	病原学结果	病原学阴性=0,病原学阳性=1,无结果=2
X₆	患者来源	健康体检=1,转诊=2,追踪=3,因症就诊=4,推介=5
X₇	地区分布	喀什市=1,疏勒县=2,疏附县=3,英吉沙县=4,伽师县=5,岳普湖县=6,莎车县=7,泽普县=8,叶城县=9,麦盖提县=10,巴楚县=11,塔什库尔干县=12