Active screening and influencing factor analysis of pulmonary tuberculosis among elderly people

doi:10.19982/j.issn.1000-6621.20240457

Abstract

Abstract:

Objective: By conducting continuous active tuberculosis screening among elderly people aged 65 and above, the study aims to evaluate the implementation effect and influencing factors of active screening in the elderly, providing data support for precise formulation of tuberculosis prevention and control measures among the elderly. Methods: From 2020 to 2023, we conducted face-to-face questionnaire survey and digital radiography (DR) examination for the elderly people in four counties/districts and four townships/streets in Rizhao City for four consecutive years. We performed univariable analysis on characteristics, previous tuberculosis history, and close contact history with tuberculosis patients, as well as multivariable logistic regression analysis, to analyze the effectiveness and influencing factors of active screening for tuberculosis among the elderly population. Results: From 2020 to 2023, 21876, 18575, 1789, and 19883 people were screened respectively, totaling 77723 person-times, and 123 cases of pulmonary tuberculosis were detected, with a detection rate of 158.25/100000. The detection rate for male (240.97/100000, 82/34029) was significantly higher than that for female (93.83/100000, 41/43694,χ²=26.212,P<0.001); The detection rate of active pulmonary tuberculosis increased from 118.24/100000 (51/4133) in those aged 65-74 years old to 448.43/100000 (5/1115) in people aged 85-108 years old; Detection rates among people with pulmonary tuberculosis history and close contact history with pulmonary tuberculosis patients were 479.70/100000 (39/8130) and 519.02/100000 (103/19845), respectively. Screening was conducted at the same research site for four consecutive years from 2020 to 2023, and as the times of screening increased, the detection rates of active pulmonary tuberculosis in the elderly people showed a downward trend ($\chi_{\text {trend }}^{2}$=14.682,P<0.001) and the etiological positive rate showed a downward trend ($\chi_{\text {trend }}^{2}$=12.749,P<0.001)too. Logistic multivariable analysis showed that higher age (75-84 years and 85-108 years) was risk factor for pulmonary tuberculosis (OR (95%CI)=8.25 (1.95-35.83), 12.53 (3.03-55.12)). Conclusion: Conducting active screening among elderly people can quickly identify patients with pulmonary tuberculosis, thereby reducing the epidemic of tuberculosis. After multiple screenings, the detection rates of active pulmonary tuberculosis among the elderly showed a significant downward trend. It is necessary to optimize screening strategy based on frequency of screening, screening methods, and risk factors of the population.

Key words: Tuberculosis, pulmonary, Aged, Factor analysis, statistics

CLC Number:

R52
R195

Qin Xueling, Chen Li, Sun Xiaoying, Hu Shanpeng, Lu Zhen, He Nailing, Zhang Jifen. Active screening and influencing factor analysis of pulmonary tuberculosis among elderly people[J]. Chinese Journal of Antituberculosis, 2025, 47(3): 355-361. doi: 10.19982/j.issn.1000-6621.20240457

Figures/Tables 6

年份	实筛人数	活动性肺结核		病原学阳性肺结核		分子生物学利福平耐药筛查
年份	实筛人数	例数	检出率 (/10万)	例数	检出率 (/10万)	利福平敏感例数	检出率 (/10万)	利福平耐药例数	检出率 (/10万)
2020	21876	49	223.99	25	114.28	13	59.43	12	54.85
2021	18575	35	188.43	18	96.90	11	59.22	7	37.69
2022	17389	22	126.52	12	69.01	9	51.76	3	28.75
2023	19883	17	85.50	10	50.29	9	45.26	1	15.09
$χ 趋势 2$ 值		14.682		12.749		5.073
P值		<0.001		<0.001		0.024

影响因素	β值	s $x ˉ$ 值	Wald χ² 值	P值	OR(95%CI)值
性别(以“女性”为参照)
男性	1.968	0.726	0.685	0.453	1.19(0.74~2.01)
年龄组(岁)(以“65~74岁”为参照)
75~84	2.621	0.708	8.264	0.000	8.25(1.95~35.83)
85~108	4.229	0.622	16.625	0.000	12.53(3.03~55.12)

References 23

[1]	舒薇, 刘宇红. 矢志革新履践致远:《2024年全球结核病报告》结核病科学研究章节解读. 中国防痨杂志, 47(2):137-141. doi:10.19982/j.issn.1000-6621.20240559.
[2]	中华人民共和国国家卫生健康委员会疾病预防控制局. 2020年全国法定传染病疫情概况. 2021-03-12. http:www.nhc.gov.cn/jkj/s3578/202103/f1a448b7df7d4760976fea6d55834966.shtml.
[3]	中华人民共和国国家卫生健康委员会疾病预防控制局. 2021年全国法定传染病疫情概况. 2022-04-22. http:www.nhc.gov.cn/jkj/s3578/202204/4fd88a291d914abf8f7a91f6333567e1.shtml.
[4]	中国防痨协会结核病控制专业分会, 中国防痨协会老年结核病防治专业分会,《中国防痨杂志》编辑委员会. 中国社区肺结核主动筛查循证指南. 中国防痨杂志, 2022, 44(10):987-997. doi:10.19982/j.issn.1000-6621.20220321.
[5]	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..
[6]	张灿有, 陈彬, 叶建君, 等. 中国重点人群肺结核患病与发病调查分析. 中国防痨杂志, 2021, 43(12):1260-1268. doi:10.3969/j.issn.1000-6621.2021.12.006.
[7]	Word Health Organization. WHO consolidated guidelines on tuberculosis. Module 2: screening-Systematic screening for tuberculosis disease. Geneva: Word Health Organization, 2021.
[8]	Senkoro M, Hinderaker SG, Mfinanga SG, et al. Health care-seeking behaviour among people with cough in Tanzania: Findings from a tuberculosis prevalence survey. Int J Tuberc Lung Dis, 2015, 19(6):640-646. doi:10.5588/ijtld.14.0499. pmid: 25946352
[9]	中华人民共和国国家卫生和计划生育委员会. WS 196—2017 结核病分类. 结核与肺部疾病杂志, 2024, 5(4): 379-380. doi:10.19983/j.issn.2096-8493.2024055.
[10]	中华人民共和国国家卫生和计划生育委员会. WS 288—2017 肺结核诊断. 结核与肺部疾病杂志, 2024, 5(4): 376-378. doi:10.19983/j.issn.2096-8493.2024022.
[11]	国家卫生健康委员会办公厅. 国家卫生健康委办公厅关于印发中国结核病预防控制工作技术规范(2020年版)的通知.国卫办疾控函〔2020〕279号. 2020-04-02.
[12]	World Health Organization. Systematic screening for active tuberculosis: principles and recommendations. Geneva: World Health Organization, 2013.
[13]	张灿有, 陈卉, 张慧, 等. 2011—2020年全国65岁及以上老年人肺结核报告发病情况分析. 中华疾病控制杂志, 2022, 26(11):1252-1258. doi:10.16462/j.cnki.zhjbkz.2022.11.003.
[14]	滕人聪, 李涛, 李玉红, 等. 2015—2021年全国65岁及以上老年肺结核患者登记情况分析. 中国防痨杂志, 2023, 45(4):367-371. doi:10.19982/j.issn.1000-6621.20220494.
[15]	代炳芹, 张艺馨, 孙晓英, 等. 2013―2022年山东省65岁及以上老年人肺结核流行特征及空间聚集性. 中华疾病控制杂志, 2024, 28(2):131-137,170. doi:10.16462/j.cnki.Zhjbkz.2024.02.002.
[16]	张慧, 成君, 于艳玲, 等. 基于社区的重点人群肺结核主动发现干预效果评价:多中心前瞻性队列研究. 中国防痨杂志, 2021, 43(12): 1248-1259. doi:10.3969/j.issn.1000-6621.2021.12.005.
[17]	周林, 刘二勇, 孟庆琳, 等. 《WS 288—2017肺结核诊断》标准实施后肺结核诊断质量评估分析. 中国防痨杂志, 2020, 42(9):910-915. doi:10.3969/j.issn.1000-6621.2020.09.005.
[18]	赵竞男, 何旺瑞. 江西省 2012—2017年痰涂片镜检室间质量评估分析. 实验与检验医学, 2020, 38(2):257-259. doi:10.3969/i.issn.1674-1129.2020.02.015.
[19]	Cohen JF, Korevaar DA, Altman DG, et al. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open, 2016, 6(11): e01299. doi:10.1136/bmjopen-2016-012799.
[20]	董裕, 逄宇. 重视无痰患者肺结核诊断发掘舌拭子替代潜能. 中国防痨杂志, 2023, 45(12):1131-1133. doi:10.19982/j.issn.1000-6621.20230379.
[21]	陈卉, 孙彦波, 沈鑫, 等. 老年人群肺结核主动发现及患者特征分析. 中国防痨杂志, 2021, 43(6): 550-556. doi:10.3969/j.issn.1000-6621.2021.06.006.
[22]	Zhang CY, Zhao F, Xia YY, et al. Prevalence and risk factors of active pulmonary tuberculosis among elderly people in China: a population based cross-sectional study. Infect Dis Poverty, 2019, 8(1): 7. doi:10.1186/s40249-019-0515-y.
[23]	国家卫生计生委办公厅. 国家卫生计生委办公厅关于印发结核病患者健康管理服务规范的通知.国卫办基层函〔2015〕880号. 2015-10-15.

人口特征	应筛查		问诊筛查		χ²值	P值
人口特征	人数(名)	构成比(%)	人数(名)	构成比(%)	χ²值	P值
性别					0.006	0.936
男性	36905	43.80	34029	43.78
女性	47349	56.20	43694	56.22
年龄组(岁)					0.372	0.830
65~74	46723	55.45	43133	55.50
75~84	36292	43.07	33475	43.07
85~108	1239	1.47	1115	1.43

年份	应检人数	肺结核可疑症状问诊		胸部DR检查		病原学检查
年份	应检人数	问诊人数	有可疑症状者	DR检查人数	胸部DR异常	应检查人数	实际检查
2020	22756	21876(96.13)	451(1.98)	20064(88.17)	1543(6.78)	1885(8.28)	1042(4.58)
2021	20568	18575(90.31)	263(1.28)	16962(82.47)	1055(5.13)	1254(6.10)	658(3.20)
2022	18676	17389(93.11)	87(0.47)	14428(77.25)	723(3.87)	775(4.15)	245(1.31)
2023	22254	19883(89.35)	96(0.43)	17885(80.37)	516(2.32)	612(2.75)	387(1.74)
合计	84254	77723(92.25)	897(1.06)	69339(82.30)	3837(4.55)	4271(5.07)	2332(2.77)

影响因素	实筛人数	病原学阳性肺结核		活动性肺结核		χ²值	P值	OR(95%CI)值
影响因素	实筛人数	例数	检出率 (/10万)	例数	检出率 (/10万)	χ²值	P值	OR(95%CI)值
性别						26.212	<0.001	2.568(1.766~3.735)
男性	34029	53	155.75	82	240.97
女性	43694	12	27.46	41	93.83
年龄组(岁)						14.032	<0.001
65~74	43133	25	57.96	51	118.24			-
75~84	33475	37	110.53	67	200.15			1.694(1.177~2.439)
85~108	1115	3	269.06	5	448.43			3.805(1.516~9.552)
职业						8.090	0.018
农牧渔民	48859	54	110.52	92	188.30			2.289(1.110~4.709)
家务工作者	19163	6	31.31	23	120.02			1.456(0.651~3.256)
其他^a	9701	5	51.54	8	82.47			-
文化程度				123		4.222	0.238
文盲或半文盲	26461	25	94.48	49	185.18
小学	33044	28	84.74	43	130.13
初中	13760	9	65.41	26	188.95
高中及其他^b	4458	3	67.29	5	112.16
婚姻状况						0.036	0.850	0.966(0.677~1.380)
已婚	42942	33	76.85	69	160.68
其他^c	34781	32	92.00	54	155.26
吸烟史						25.143	<0.001	2.412(1.691~3.440)
有	20029	29	144.79	56	279.59
无	57694	36	62.40	67	116.13
糖尿病病史						30.937	<0.001	2.656(1.857~3.800)
有	26416	16	60.57	71	268.78
无	51307	49	95.50	52	101.35
肺结核病史						59.107	<0.001	3.978(2.719~5.819)
有	8130	6	73.80	39	479.70
无	69593	59	84.78	84	120.70
肺结核患者密切接触史						219.521	<0.001	15.093(9.347~24.372)
有	19845	6	30.23	103	519.02
无	57878	59	101.94	20	34.56

变量	赋值	变量	赋值
肺结核	是=1;否=0	婚姻状况	已婚=1;其他^c=2
性别	男性=1;女性=2	糖尿病病史	有=1;无=0
年龄组	65~74岁=1;75~84岁=2;85~108岁=3	吸烟史	有=1;无=0
职业	农牧渔民=3;家务工作者=2;其他^a=1	肺结核病史	有=1;无=0
文化程度	文盲或半文盲=4;小学=3;初中=2;高中及其他^b=1	肺结核患者密切接触史	有=1;无=0