| Objectives:1.To construct a monitoring and early warning index system which adapt to tuberculosis popularity characteristics in our country, supporting the warning and controlling of tuberculosis with important index of high sensitivity, good timeliness and strongly maneuverability, thus providing tuberculosis prevention and control of with powerfully scientific basis.2. To obtain tuberculosis prevalence and incidence in different areas, and to understand the incidence characteristics of rural, urban and floating populations, so as to provid further tuberculosis control and prevention with reference of different characteristics of the groups.3. To discuss the influence factors of incidence of the whole population and contribution of expose conditions to the incidence in four different fields, according to the results of this study to propose prevention and control measures reasonably.Methods:1.Both the qualitative and quantitative research methods were used for tuberculosis monitoring and early warning index system construction, literature study, the Delphi method and expert meeting method were included. 2.The Cross-sectional survey method was used to get demographic data and prevalence of the population, then the observation object were followed-up to obtain the annual incidence and its features.3.Using a chi-square test for single variables analysis of factors which affect the total population's incidence, with the Cox model for multivariate analysis. According to the characteristics whether can be changed or not, they were divided to background variables which can not be adjusted and risk factors which were adjustable. SAS program was used to calculate full population attributable risk percentage (PARF) and partial population attributable risk percentage (PARP) of risk factors, so as to determine the contribution of factors and the different combination of them to tuberculosis incidence.Results:1. In this study, a total of 18 experts attended two rounds of expert consultation. A monitoring and early warning index system of tuberculosis including 4 primary indexes,9 secondary indexes and 48 third indexes was build. The first round of the expert familiarity degree ranged 0.508-0.967, and the mean score was 0.801. Authority coefficient ranged 0.704-0.933, and the mean score was 0.850. The second round of the expert familiarity degree ranged 0.840-0.967, and the mean score was 0.922. Authority coefficient ranged 0.893-0.957, and the mean score was 0.917. The weight was calculated by normalization method and the top five indexes were: notification of new smear positive case, cure rate, complete treatment rates, the overall rate of patient in place and the regional distribution of tuberculosis.2. Guangdong, Hunan, Shanghai and Jiangsu were chosen to represent the floating population, the mid rural population, the eastern rural population and the urban population. The prevalence of total population was 63.55/100,000. The prevalence of active tuberculosis of Guangdong, Hunan, Shanghai and Jiangsu was 103.23/100,000, 122.89/100,000,16.52/100,000,46.21/100,000 respectively. When standardized with merged population, the incidence density of the active tuberculosis was 41.75/100,000, and the incidence density of smear positive case was 18.59/100,000. The incidence density of the active tuberculosis after standardization was different in four fields.3. Multivariate analysis shown male (RR= 2.67,95%CI:1.80-3.97), age increase pre five years (RR=1.18,95% CI:1.03-1.36), tuberculosis history (RR= 3.83,95% CI: 2.00-7.31) and married (RR= 2.1,95% CI:1.09-8.30) may increase the risk of disease. For students and children (RR= 0.12,95% CI:0.02-0.57) or population with education level above junior school (RR= 0.81,95% CI:0.67-0.99), the risk was lower.4 The population in four fields shared the same risk factors of tuberculosis history. Other factors contributed differently in four study sites. In Guangdong and Shanghai population, smoking contributed most to the disease (Guangdong:PARF= 8.02%, PARP= 6.26%, Shanghai:PARF= 23.99%, PARP= 20.61%), in Hunan and Jiangsu, the history of tuberculosis was the greatest contribution to incidence (Hunan:PARF= 9.24%, PARP= 7.85%, Jiangsu:PARF= 21.90%, PARP= 17.32%). If measures can be taken to reduce the history of tuberculosis, contact history with patient, smoking and diabetes in the crowd, the incidence of Guangdong, Hunan, Shanghai and Jiangsu can at least drop by 11.50%,13.83%,33.37% and 47.73%.Conclusions:1. The score of coordination and concentration degree of the warning indicator system were high, that shown the index system adapt to our country's characteristics of tuberculosis, and could provide our prevention and control measure of powerfully scientific basis.2. Tuberculosis was highly concentrated in the less developed areas and the mid rural area in China, then also among the floating population. It was showed that rural areas and undeveloped areas were the keys of prevention and control work, and measures should point to elderly and male on case detection and treatment. 3. In process of prevention and control of tuberculosis, the key point was to control the source of infection and improve the case detection rate and the cure rate. In carrying out health education, advocating quit smoking and control of blood sugar were also effective measures to reduce incidence of tuberculosis.Innovations:1. This is the first time to establish tuberculosis monitoring and early warning index system in China, the system is useful for tuberculosis forecast. At the same time, it can work as methodology in index system construction of respiratory infections single disease monitoring and warning.2. At the domestic, this is the first time to establish such a large-scale observation field, and, the incidence data is obtained directly.3 It is the first time to introduce the concept of full population attributable risk and partial population attributable risk to distinguish the contribution of disease incidence between background variables and exposure conditions.
|
PDF Full Text Request