2015—2023年陕西省安康市老年肺结核患者流行特征及就诊延迟分析  

Epidemiological characteristics and delay in seeking medical care among elderly patients with pulmonary tuberculosis in Ankang City of Shaanxi Province from 2015 to 2023

作　　者：焦欢[1] 李奎 马倩 屈娅荣[1] 周以军[1] 刘芙蓉[1] 郑开安[1] 蒋伟 JIAO Huan;LI Kui;MA Qian;QU Yarong;ZHOU Yijun;LIU Furong;ZHENG Kaian;JIANG Wei(Department of Tuberculosis Control,Ankang Center for Disease Control and Prevention,Ankang 725000,Shaanxi Province,China;Ankang Central Hospital,Ankang 725000,Shaanxi Province,China;Department of Respiratory and Critical Care Medicine,Ankang Hospital of Traditional Chinese Medicine,Ankang 725000,Shaanxi Province,China)

机构地区：[1]安康市疾病预防控制中心结核病防制科,陕西安康725000 [2]安康市中心医院传染病医院,陕西安康725000 [3]安康市中医医院呼吸与危重症医学科,陕西安康725000

出　　处：《预防医学情报杂志》2025年第3期305-311,319,共8页Journal of Preventive Medicine Information

基　　金：陕西省重点研究发计划(项目编号:2024SF-YBXM-278)。

摘　　要：目的对陕西省安康市老年肺结核流行病学特征进行汇总分析,为老年肺结核防治策略制定提供技术支持。方法收集2015—2023年安康市60岁以上老年肺结核患者就诊、治疗、管理等资料,采用趋势分析、单因素分析、多样本率比较、Logistics回归分析等进行流行特征及就诊延迟因素分析,检验水准为α=0.05。结果2015—2023年安康市老年肺结核发病率总体呈下降趋势,其中2017—2020年下降趋势最明显(APC=-16.52,95%CI:-20.91~-13.25,P<0.001);全年总体呈下降趋势(APC=-2.66,95%CI:-3.89~-1.43,P<0.001),1至3月和5至8月发病较高;男性患者是女性的2.63倍;年龄中位数为67(63,71)岁;农民占老年发病总人数的89.05%;2020—2023年60岁以上老年结核耐药发病率呈上升趋势(APC=15.78,95%CI:5.43~27.18,P<0.001),耐药率为7.16%,其中单耐药率、耐多药率、准广泛耐药率分别为6.05%、1.04%、0.07%;复治患者比初治更容易产生耐药(χ^(2)=51.61,P<0.001)。Logistics回归分析显示:相对于非农民,农民增加就诊延迟发生风险(OR=1.402,95%CI:1.177~1.670,P<0.001);合并其他疾病的老年人群发生就诊延迟的风险更高(OR=1.371,95%CI:1.177~1.598,P<0.001);而流动老年人群相对于本地人口更容易发生就诊延迟(OR=1.192,95%CI:1.014~1.401,P<0.05)。结论在今后的结核病防治工作中,重点关注老年、男性、农民、复治患者等人群,制定综合措施降低普通肺结核和耐药结核的发生和传播。农民、合并疾病、流动人口是安康市老年群体就诊延迟的因素,应采取综合措施避免就诊延迟。Objective To summarize and analyze the epidemiological characteristics of elderly patients with pulmonary tuberculosis in Ankang City,Shaanxi Province,and to provide technical support for the formuation of prevention and control strategies of pulmonary tuberculosis among the elderly patients.Methods Data on medical treatment,treatment and management of patients with pulmonary tuberculosis over 60 years old in Ankang City from 2015 to 2023 were collected.Trend analysis,univariate analysis,multiple sample rate comparison and Logistic regression analysis were used to analyze the epidemiological characteristics and factors of delay in seeking medical care.The level wasα=0.05.Results From 2015 to 2023,the incidence rate of the elderly with pulmonary tuberculosis in Ankang City generally showed a downward trend,and the downward trend was the most obvious from 2017 to 2020(annual percentage change APC=-16.52,95%confidence interval CI:-20.91--13.25,P<0.001).There was a downward trend in the whole year(APC=-2.66,95%CI:-3.89--1.43,P<0.001),and the incidence was higher in January-March and May-August.The number of male patients was 2.63 times that of female patients.The median age was 67(63,71)years old.Farmers accounted for 89.05%of the total number of elderly patients.The incidence of tuberculosis drug resistance in elderly people over 60 years old showed an upward trend from 2020 to 2023(APC=15.78,95%CI:5.43-27.18,P<0.001).The drug resistance rate was 7.16%,of which the single drug resistance rate,multi-drug resistance rate and quasi-extensive drug resistance rate were 6.05%,1.04%and 0.07%,respectively.Retreated patients were more likely to develop drug resistance than initially treated patients(χ^(2)=51.61,P<0.001).Logistic regression analysis showed that compared with non-farmers,farmers increased the risk of delay in seeking medical care(odds ratio OR=1.402,95%CI:1.177-1.670,P<0.001).Elderly patients with other diseases had a higher risk of delay in seeking medical care(OR=1.371,95%CI:1.177-1.598,P<0.001).Floating e

关 键 词：老年 结核 耐药 就诊延迟 APC Logistics回归 

分 类 号：R512[医药卫生—内科学] R181.3[医药卫生—临床医学]