云南省病原学阳性肺结核患者总延迟变化趋势

律彤; 杨蕊; 陈金瓯; 李玲; 邱玉冰; 许琳

doi:10.16462/j.cnki.zhjbkz.2022.05.010

云南省病原学阳性肺结核患者总延迟变化趋势

doi: 10.16462/j.cnki.zhjbkz.2022.05.010

律彤¹,
杨蕊²,
陈金瓯²,
李玲²,
邱玉冰²,
许琳^2, ,

1.
650500 昆明，昆明医科大学公共卫生学院
2.
650022 昆明，云南省疾病预防控制中心结核病防治所

详细信息

通讯作者:
许琳，E-mail: 123316859@qq.com

中图分类号: R181.1;R52
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- 被引次数: 0
出版历程
- 收稿日期: 2021-08-12
- 修回日期: 2021-11-24
- 网络出版日期: 2022-05-11
- 刊出日期: 2022-05-10

Analysis of the trend of total delay among pulmonary tuberculosis patients with positive etiology in Yunnan Province

1.
School of Public Health, Kunming Medical University, Kunming 650500, China
2.
Tuberculosis Prevention Center, Yunnan Center for Disease Control and Prevention, Kunming 650022, China

More Information

Corresponding author: XU Lin, E-mail: xulinth@hotmail.com

摘要

摘要: 目的分析“十一五”“十二五”和“十三五”中国结核病防治规划期间云南省病原学阳性肺结核患者总延迟时间的变化趋势，获得影响总延迟发生的影响因素，为减少总延迟的发生提供依据。方法利用《结核病管理信息系统》中登记报告的云南省2005年、2010年、2015年和2020年病原学阳性肺结核患者的病案资料。描述最终纳入研究患者的人口学特征、延迟特征。构成比的时间趋势检验用χ²趋势检验，采用Kaplan-Meier法进行组间患者总延迟的比较，估计生存概率并绘制生存函数曲线，用Cox比例风险模型进行患者总延迟发生的多因素分析。结果云南省病原学阳性肺结核患者的总延迟整体呈下降趋势，且下降趋势与就诊延迟相似。总延迟中位数由2005年的94 d降至2020年的33 d，2020年患者确诊并接受治疗的概率较2005年增长了2.359倍，不同特征患者的总延迟天数均呈下降趋势。多因素回归分析结果显示，除年份外，女性、高年龄、农民、少数民族、流动人口和复治患者也是发生总延迟的危险因素。结论在云南省结核病防控措施的实行下，病原学阳性肺结核患者总延迟天数下降，有效控制了结核病疫情的发展。应侧重于降低总延迟天数较高的危险人群的就诊延迟, 寻求符合成本-效益的主动筛查方式，进一步控制结核病疫情发展。
- 肺结核 /
- 病原学阳性 /
- 总延迟 /
- 趋势分析 /
- 云南省
Abstract: Objective To analyze the trend of total delay of tuberculosis patients with positive etiology in Yunnan Province during the 11th five-year Plan, 12th five-year Plan and 13th five-year Plan for tuberculosis prevention and control, and to obtain the influencing factors of total delay, so as to provide the basis for reducing the occurrence of total delay. Methods Via the tuberculosis management information system(TMIS), we collected medical records of patients with pathogen-positive pulmonary tuberculosis registered in Yunnan Province in 2005, 2010, 2015 and 2020. The demographic characteristics and delay characteristics of the study participants were described. χ² trend test was used for the time trend test of rate and composition ratio, and the Kaplan-Meier method was used to compare the total delay between groups, and the survival probability was estimated and drawn as a survival function curve. Cox proportional hazard model was used for multivariate analysis of total delay. Results The total delay of positive etiology pulmonary tuberculosis patients in Yunnan Province has declined, and the declining trend was similar to patient delay. The median total delay was reduced from 94 days in 2005 to 33 days in 2020. The probability of patients with pathogenic positive pulmonary tuberculosis being found and receiving treatment in 2020 increased by 2.359 times compared with 2005, and the total delay days of patients with different characteristics showed a downward trend. Multivariate regression analysis showed that besides years, women, older age, farmers, ethnic minorities, floating population and retreatment patients were also risk factors for the total delay. Conclusions With the implementation of tuberculosis prevention, and control measures in Yunnan Province, the total delay days of patients with positive pathogenic tuberculosis decreased significantly, which effectively controlled the development of tuberculosis epidemic. To further control the development of the tuberculosis epidemic, we should pay attention to the risk groups with long total delay days, and seek cost-effective active screening methods to reduce the patient delay of dangerous people.
- Pulmonary tuberculosis /
- Positive etiology /
- Total delay /
- Trend analysis /
- Yunnan Province

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图 1 2005-2020年病原学阳性肺结核患者总延迟趋势

Figure 1. The total delay trend of pathogenic positive pulmonary tuberculosis patients from 2005 to 2020

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表 1 病原学阳性患者的基本情况[n(%)]

Table 1. Characteristics of tuberculosis patients with positive etiology [n(%)]

变量	合计	2005年	2010年	2015年	2020年	χ_趋势²值	P值
变量	N=41 106	n=11 500	n=13 251	n=5 200	n=11 155	χ_趋势²值	P值
性别						34.58	＜0.001
男	28 327(68.91)	7 684(66.82)	9 202(69.44)	3 660(70.38)	7 781(69.75)
女	12 779(31.09)	3 816(33.18)	4 049(30.56)	1 540(29.62)	3 374(30.25)
年龄(岁)						1 411.49	＜0.001
0~ < 15	268(0.65)	94(0.82)	62(0.47)	31(0.60)	81(0.73)
15~ < 25	6 471(15.74)	2 161(18.79)	2 254(17.01)	709(13.63)	1 347(12.08)
25~ < 35	7 750(18.85)	2 644(22.99)	2 736(20.65)	887(17.06)	1 483(13.29)
35~ < 45	7 609(18.51)	2 239(19.46)	2 616(19.74)	1 053(20.25)	1 701(15.25)
45~ < 55	7 192(17.50)	1 735(15.09)	2 146(16.20)	1 015(19.52)	2 296(20.58)
55~ < 65	6 022(14.65)	1 465(12.74)	1 918(14.47)	776(14.92)	1 863(16.70)
≥65	5 794(14.10)	1 162(10.10)	1 519(11.46)	729(14.02)	2 384(21.37)
民族						6 580.92	＜0.001
汉族	28 421(69.14)	11 340(98.61)	7 987(60.27)	2 815(54.13)	6 279(56.29)
其他民族	12 685(30.86)	160(1.39)	5 264(39.73)	2 385(45.87)	4 876(43.71)
职业						122.99	＜0.001
农民	34 171(83.13)	9 390(81.65)	10 913(82.36)	4 369(84.02)	9 499(85.15)
学生	1 673(4.07)	549(4.77)	470(3.55)	158(3.04)	496(4.45)
其他	5 262(12.80)	1 560(13.57)	1 866(14.08)	673(12.94)	1 160(10.40)
户籍						1 032.58	＜0.001
本地	37 644(91.58)	11 056(96.14)	12 481(94.19)	4 520(86.92)	9 587(85.94)
流动	3 462(8.42)	444(3.86)	770(5.81)	680(13.08)	1 568(14.06)
治疗分类						220.60	＜0.001
初治	36 594(89.02)	9 879(85.90)	12 155(91.72)	4 678(89.96)	9 882(88.59)
复治	4 512(10.98)	1 621(14.10)	1 096(8.27)	522(10.04)	1 273(11.41)

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表 2 2005-2020年云南省病原学阳性肺结核患者延迟趋势

Table 2. Delayed trend of pathogenic positive pulmonary tuberculosis patients in Yunnan Province from 2005 to 2020

变量	2005年	2010年	2015年	2020年
总延迟
极值(Min, Max)	(0, 1 094)	(0, 1 087)	(0, 1 095)	(0, 1 086)
中位数[M(P₂₅, P₇₅)]	94(43, 207)	59(29, 109)	55(25, 102)	33(13, 72)
aHR(95% CI)值	1	1.562(1.521, 1.605) ^a	1.707(1.648, 1.768) ^a	2.359(2.291, 2.429) ^a
就诊延迟
极值(Min, Max)	(0, 1 093)	(0, 1 084)	(0, 1 090)	(0, 1 086)
中位数[M(P₂₅, P₇₅)]	59(22, 141)	45(18, 98)	43(16, 92)	26(7, 62)
aHR(95% CI)值	1	1.218(1.188, 1.249) ^a	1.280(1.238, 1.322) ^a	1.756(1.710, 1.803) ^a
确诊延迟
极值(Min, Max)	(0, 1 087)	(0, 821)	(0, 731)	(0, 1 033)
中位数[M(P₂₅, P₇₅)]	2(1, 24)	2(0, 6)	1(0, 7)	1(0, 7)
aHR(95% CI)值	1	1.484(1.443, 1.526) ^a	1.621(1.564, 1.681) ^a	1.707(1.656, 1.759) ^a
治疗延迟
极值(Min, Max)	(0, 730)	(0, 366)	(0, 563)	(0, 264)
中位数[M(P₂₅, P₇₅)]	1(0, 2)	1(0, 1)	0(0, 1)	0(0, 0)
aHR(95% CI)值	1	1.348(1.312, 1.385) ^a	1.905(1.838, 1.974) ^a	2.048(1.989, 2.109) ^a
注：^aCox比例风险回归模型P＜0.001。

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表 3 不同特征患者的总延迟趋势

Table 3. Total delay trend of different patient characteristics

变量	2005年		2010年		2015年		2020年
变量	总延迟天数 M(P₂₅, P₇₅)	HR(95% CI)值	总延迟天数 M(P₂₅, P₇₅)	HR(95% CI)值	总延迟天数 M(P₂₅, P₇₅)	HR(95% CI)值	总延迟天数 M(P₂₅, P₇₅)	HR(95% CI)值
性别
男	93 (42, 205.75)	1	58 (28, 107)	1.612 (1.564, 1.663) ^a	53 (24, 100)	1.742 (1.674, 1.813) ^a	32 (12, 73)	2.278 (2.206, 2.353) ^a
女	96.5 (45, 211)	1	61 (31, 114)	1.630 (1.559, 1.706) ^a	60 (28, 112.75)	1.650 (1.554, 1.751) ^a	34 (13, 72)	2.429 (2.316, 2.547) ^a
年龄(岁)
0~ < 15	75 (36, 148.5)	1	47 (21.75, 87.75)	1.622 (1.167, 2.255) ^a	44 (17, 87)	1.895 (1.247, 2.880) ^a	35 (10.5, 66)	2.338 (1.712, 3.193) ^a
15~ < 25	74 (37, 176)	1	57 (27, 100)	1.459 (1.374, 1.549) ^a	48 (22, 91.5)	1.600 (1.469, 1.743) ^a	31 (11, 68)	2.146 (2.003, 2.299) ^a
25~ < 35	94 (42, 212.75)	1	58 (28, 107)	1.735 (1.643, 1.834) ^a	56 (25, 108)	1.742 (1.613, 1.881) ^a	31 (11, 67)	2.599 (2.435, 2.774) ^a
35~ < 45	100 (45, 217)	1	62 (30, 114)	1.660 (1.568, 1.759) ^a	60 (29, 111)	1.694 (1.573, 1.825) ^a	35 (13, 77.5)	2.343 (2.197, 2.500) ^a
45~ < 55	104 (47, 242)	1	60 (31, 109.25)	1.729 (1.621, 1.844) ^a	56 (25, 103)	1.885 (1.742, 2.040) ^a	34 (13, 77)	2.411 (2.262, 2.571) ^a
55~ < 65	102 (49, 212.5)	1	61 (29, 116)	1.644 (1.534, 1.761) ^a	58 (27, 104)	1.810 (1.657, 1.977) ^a	34 (14, 72)	2.403 (2.240, 2.578) ^a
≥65	91 (43, 208)	1	59 (27, 112)	1.529 (1.416, 1.652) ^a	50 (24.5, 98)	1.694 (1.543, 1.860) ^a	32 (13, 71)	2.251 (2.096, 2.418) ^a
民族
汉族	94 (43, 207)	1	57 (28, 106)	1.663 (1.615, 1.712) ^a	53 (25, 97)	1.802 (1.729, 1.879) ^a	32 (12, 72)	2.419 (2.344, 2.497) ^a
其他民族	94.5 (41.25, 213.5)	1	62 (30, 113)	1.509 (1.289, 1.766) ^a	57 (25, 112)	1.569 (1.337, 1.841) ^a	34 (13, 72)	2.133 (1.822, 2.497) ^a
职业
农民	98 (45, 216)	1	61 (30, 111)	1.649 (1.604, 1.696) ^a	57 (26，104)	1.746 (1.684, 1.811) ^a	33 (13, 73)	2.382 (2.313, 2.452) ^a
学生	65 (31, 119.5)	1	45 (22, 86.5)	1.342 (1.185, 1.519) ^a	35 (17, 81.25)	1.621 (1.356, 1.938) ^a	29 (10, 65.75)	1.965 (1.735, 2.225) ^a
其他	77 (38, 182)	1	51 (23, 101)	1.554 (1.451, 1.663) ^a	47 (23, 101.5)	1.636 (1.493, 1.792) ^a	34 (12, 72)	2.141 (1.981, 2.314) ^a
户籍
本地	94 (43, 208)	1	59 (29, 108)	1.628 (1.586, 1.671) ^a	56 (26, 101)	1.725 (1.665, 1.786) ^a	32 (12, 71)	2.348 (2.283, 2.414) ^a
流动	96.5 (46.5, 195)	1	58 (28, 123)	1.469 (1.306, 1.653) ^a	52 (22, 112.5)	1.614 (1.430, 1.822) ^a	40 (16, 79)	2.138 (1.920, 2.382) ^a
治疗分类
初治	80 (39, 174)	1	60 (29, 107)	1.394 (1.357, 1.431) ^a	54 (25, 100)	1.491 (1.440, 1.544) ^a	32 (13, 70)	2.093 (2.035, 2.153) ^a
复治	356 (147, 566.5)	1	56 (33, 143.75)	3.490 (3.214, 3.790) ^a	64.5 (29, 128.75)	3.523 (3.177, 3.906) ^a	41 (14, 125.5)	3.917 (3.620, 4.238) ^a
注：^aCox比例风险回归模型P＜0.001。

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表 4 不同特征患者的总延迟多因素分析

Table 4. The results of total delay of different patient characteristics by Cox regression analysis

变量	β值	s_x值	χ²值	HR调整(95% CI)	P值
年份(年)
2005				1.000
2010	0.446	0.014	1 038.781	1.562(1.521, 1.605)	＜0.001
2015	0.535	0.018	890.356	1.707(1.648, 1.768)	＜0.001
2020	0.858	0.015	3 312.773	2.359(2.291, 2.429)	＜0.001
性别
男	0.052	0.011	23.525	1.054(1.032, 1.076)	＜0.001
女				1.000
年龄(岁)					＜0.001
0~ < 15	0.096	0.068	2.018	1.101(0.964, 1.257)	0.155
15~ < 25	0.095	0.020	23.709	1.100(1.058, 1.142)	＜0.001
25~ < 35	0.041	0.018	5.327	1.04(1.006, 1.078)	0.021
35~ < 45	-0.009	0.018	0.282	0.991(0.957, 1.026)	0.596
45~ < 55	-0.018	0.018	1.081	0.98(0.948, 1.016)	0.298
55~ < 65	-0.011	0.018	0.325	0.990(0.954, 1.026)	0.569
≥65				1.000
民族
汉族	0.054	0.012	20.983	1.055(1.031, 1.080)	＜0.001
其他民族				1.000
职业					＜0.001
农民				1.000
学生	0.173	0.030	33.730	1.189(1.121, 1.260)	＜0.001
其他	0.098	0.016	38.866	1.10(1.069, 1.137)	＜0.001
户籍
本地	0.117	0.019	38.346	1.124(1.083, 1.167)	＜0.001
流动				1.000
治疗分类
初治	0.472	0.016	845.229	1.603(1.552, 1.654)	＜0.001
复治				1.000

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