2019年湖北省肺结核漏登抽样调查及影响因素分析  

Sampling survey of under-registration of pulmonary tuberculosis and influencing factors in Hubei,2019

作　　者：曾琼 张玉[3] 侯双翼[3] 笪琴[3] 卢星星[3] 皮琦[3] 杨成凤[3] 张梦娴 周丽平[3] Zeng Qiong;Zhang Yu;Hou Shuangyi;Da Qin;Lu Xingxing;Pi Qi;Yang Chengfeng;Zhang Mengxian;Zhou Liping(Hubei Standardized Training of Public Health Physician Program,Wuhan 430079,Hubei,China;Maojian District Center for Disease Control and Prevention,Shiyan 442012,Hubei,China;Tuberculosis Institute,Hubei Provincial Center for Disease Control and Prevention,Wuhan 430079,Hubei,China)

机构地区：[1]湖北省公共卫生医师规范化培训项目,湖北武汉430079 [2]十堰市茅箭区疾病预防控制中心,湖北十堰442012 [3]湖北省疾病预防控制中心结核病防治所,湖北武汉430079

出　　处：《疾病监测》2022年第5期684-688,共5页Disease Surveillance

摘　　要：目的了解2019年湖北省肺结核漏登情况的影响因素及原因。方法采用分层随机抽样抽取湖北省(县、市)具有肺结核诊断能力的定点及非定点医疗机构,对其2019年诊断为肺结核和疑似肺结核病例进行调查,评估漏登情况。结果共收集6家医疗机构21591条信息,最终核查分析肺结核患者3285例。2019年湖北省肺结核漏登率为10.23%。不同诊疗机构属性(χ^(2)=42.933,P<0.001)、机构类型(χ^(2)=6.747,P=0.009)、诊断分类(χ^(2)=18.266,P<0.001)、地区疫情程度(χ^(2)=21.989,P<0.001)及年均门诊量(χ^(2)=24.053,P<0.001)的漏登率不同,差异有统计学意义。市级漏登风险较高(与县级相比,OR=2.27,95%CI:1.77~2.92),结核性胸膜炎漏登风险较高(相较于利福平耐药肺结核,OR=6.71,95%CI:1.90~23.74)。追踪未到位和一次性就诊是主要漏登原因。结论关注湖北省肺结核漏登问题,继续提升结核病防治体系服务能力,强化各级医院的规范诊疗服务水平。Objective To understand the under-registration of pulmonary tuberculosis(TB)and analyze the influencing factors and reasons in Hubei province in 2019.Methods A stratified random sampling method was used to select designated and non-designated tuberculosis medical institutions with tuberculosis diagnosis capabilities in counties and cities of Hubei to conduct a survey of registration of pulmonary TB cases and suspected pulmonary TB cases in 2019,and evaluate the status of the under-registration.Results The information of 21591 pulmonary TB cases were collected from 6 medical institutions,finally,the information of 3285 cases were analyzed.In 2019,the under-registration rate of pulmonary TB in Hubei was 10.23%.There were statistically significant differences in under-registration rate among the institutions with different nature(χ^(2)=42.933,P<0.001),institutions of different types(χ^(2)=6.747,P=0.009),cases with different diagnosis classification(χ^(2)=18.266,P<0.001),areas with different epidemic situation(χ^(2)=21.989,P<0.001)and hospitals with different outpatient visits(χ^(2)=24.053,P<0.001).The risk for under-registration of pulmonary TB was higher at city level(compared with the county level,OR=2.27,95%CI:1.77-2.92)and in tuberculous pleurisy cases(compared with rifampicin-resistant tuberculosis cases,OR=6.71,95%CI:1.90-23.74).Failure to follow up and one-off visits were the main reasons for the under-registration of pulmonary TB.Conclusion It is necessary to pay attention to the under-registration of pulmonary TB,improve the service capacity of the TB prevention and control system,and strengthen the standardized diagnosis and treatment of pulmonary TB in hospitals in Hubei.

关 键 词：结核 肺 漏登 影响因素 监测 

分 类 号：R211[医药卫生—中医学] R521