Study On Risk Factors Of Tuberculosis Among Population In Shenyang

ObjectiveIn recent years,the decline in the tuberculosis epidemic has been slow,and there has been a trend of recovery in some countries and regions.As a country with a high burden of tuberculosis,the situation of tuberculosis in China is still very serious.At present,the main problems of tuberculosis prevention and control in China include:low rate of tuberculosis detection,low awareness of tuberculosis knowledge,frequent occurrence of drug-resistant tuberculosis,and serious delay in treatment.As a chronic infectious disease,tuberculosis is not only closely related to the exposure of infectious sources,but also related to social,economic,individual behavior,and genetic factors.Therefore,it is essential to conduct research on tuberculosis risk factors to identify high-risk groups and improve patient discovery rates for effective early intervention.This study focused on the important aspects of the development of tuberculosis,and investigated the risk factors of human beings by investigating social,environmental,individual behavior and genetic variation,so as to identify the risk factors of tuberculosis and high-risk populations in the population,and provided evidence for further risk assessment of tuberculosis,and provided possible methods and ideas for further risk assessment of tuberculosis,and gave some reference for tuberculosis screening,early detection strategies and health interventions.MethodsIn this study,a hospital-based case-control study was conducted to select tuberculosis patients who were hospitalized in Shenyang Chest Hospital from January 20 to 2018 in December 18,which were in line with the national diagnostic criteria for tuberculosis,and selected several municipalities at the same time.The healthy population of the above hospitals with no history of tuberculosis and no tuberculosis was used as healthy control group.Designed questionnaires to collect characteristics of society,economy,and individual behavior.The blood samples of the study subjects were collected,DNA was extracted,and the vitamin D receptor FokI(rs2228570)and ApaI(rs7975232)sites were analyzed by TaqMan probe method.Hardy-Weinberg equilibrium test was used.The study population reached the genetic balance;the chi-square test was used for univariate analysis,and logistic regression was used for multi-factor analysis to study the influencing factors of tuberculosis;The CHAID decision tree method was further used to analyze the relationship between social,economic,individual behavior and genetic factors and tuberculosis,and finally to select the combination of risk factors for high-risk groups.Results1.A total of 640 subjects were included,205 in the tuberculosis group and 435 in the healthy control group.The average age of the subjects was 42.74±16.86,366 males(57.19%)and 274 females(42.81%).2.Univariate analysis showed that age(?2=33.683,P<0.001),gender(?2=9.252,P=0.002),BMI(?2=35.055,P<0.001),and education level(?2=116.312,P<0.001),medical insurance(?2=27.502,P<0.001),monthly household income(?2=54.652,P<0.001),labor intensity(?2=28.733,P<0.001),smoking status(?2=19.916,P<0.001),physical exercise(?2=87.273,P<0.001),ventilation of the window(?2=5.980,P=0.014),history of BCG vaccination(?2=79.558,P<0.001)The distribution of interpersonal contact(?2=19.995,P<0.001)and TB patientsi'contact history(?2=9.894,P=0.002)was statistically significant in the TB group and the healthy group.The genotype distributions of FokI(rs2228570)and ApaI(rs7975232)were consistent with the Hardy-Weinberg equilibrium test.The FokI locus genotype distribution was 40 cases of AA genotype in TB group(19.51%),111 cases of AG genotype(54.15%),54 cases of GG genotype(26.34%);the genotype distribution of healthy control group was A A gene.There were 87 cases(20.00%),217 cases(49.89%)of AG genotype,and 131 cases(30.11%)of GG genotype.Chi-square test results showed that there was no significant difference in genotype distribution between TB group and healthy group(x2=1.197,P=0.550).The genotype distribution of ApaI loci was 111(54.15%)in CC group,81(39.51%)in AC genotype,13(6.34%)in AA genotype,and genotype distribution in healthy control group.There were 225 cases(51.72%)of CC genotype,174 cases(40.00%)of AC genotype,and 36 cases(8.28%)of AA genotype.There was no significant difference in genotype distribution between TB group and healthy group(x2=0.845,P=0.655).3.Influential factors of univariate analysis were included in multivariate logistic regression analysis.The results showed that BMI(OR=5.41 8,95%CI=2.628-11.168,P<0.001),education level(OR=3.633,95%CI=1.370-9.639,P=0.010),medical insurance(OR=0.150,95%CI=0.029-0.781,P=0.044),household income(OR=3.234,95%CI=1.51 1-0.6.925,P=0.003),Smoking(OR=2.1 89,95%CI=1.287-3.722,P=0.014),physical exercise(OR=0.210,95%CI=0.126-0.348,P<0.001),BCG vaccination history(OR=0.257,95%CI=0.147-0.450,P<0.001),interpersonal contact(OR=2.387,95%CI=1.458-3.907,P<0.001)is an important factor in the pathogenesis of tuberculosis.4.The decision tree generated by the CHAID algorithm had three layers of depth,a total of 18 nodes and 10 leaf nodes.The classification accuracy of the decision tree model was 80.00%,and the area under the ROC curve was 0.834(0.799-0.869).The decision tree screened out seven influencing factors,according to the importance degree,it was the degree of education,interpersonal contact,physical exercise,age,BCG vaccination history,marital status,and labor level.The educational level(x2=122.703)was the most important factor affecting the incidence of TB.Educational level below junior high school was the highest risk factors of tuberculosis,accounted for 66.88%,;the high school education level among the tuberculosis patients accounted for 30.08%,the university and above culture Tuberculosis patients accounted for 17.50%of the population,and it can be seen that as the level of education increases,the risk of tuberculosis was getting lower and lower.According to the index of the node index,the combination of risk factors in the high-risk population were:? educational level below junior high school+no regular physical exercise+age odder than or equal to 60 years old.?educational level below junior high school + irregular physical exercise + age less than 60 years old.?educational level below junior high school + no BCG vaccination history,?frequent interpersonal contact?no spouse.Conclusions1.Low BMI,low level of education,smoking,lower family income and frequent interpersonal contact were the risk factors of tuberculosis.Having medical insurance,regular physical exercise,and inoculating BCG vaccination were protective factors of tuberculosis.2.In this study,the genetic polymorphisms of VDR gene FokI(rs2228570)and ApaI(rs7975232)were not associated with susceptibility to tuberculosis.3.The combined risk factors selected by the decision tree are:?educational level below junior high school?no regular physical exercise+age greater than or equal to 60 years old.?educational level below junior high school?irregular physical exercise+age less than 60 years old.?educational level below junior high school + no BCG vaccination history.? interpersonal contact+no spouse.4.The results of this study suggest that the degree of education has the greatest impact on tuberculosis.Among the population whose educational level is below junior high school,health intervention targeting on regular physical exercise and BCG vaccination history can get the biggest benefit.For population with a higher level of education,health intervention targeting on interpersonal contact was suggested.