The Implementation And Predictors Of Pulmonary Tuberculosis Control Objectives In China

BackgroundPulmonary Tuberculosis(PTB),a chronic infectious disease caused by Mycobacterium tuberculosis infection,is the main cause of death attributable to a single pathogen infection and one of the global top ten causes of death.China is one of the 30 countries with high burdens of tuberculosis and ranks second both in the number of new TB cases per year and total TB cases in the world.The epidemic of tuberculosis in China displays a characteristic of slow decline in prevalence rate,large number of patients,heavy disease burden and regional development imbalance,resulting in the arduous task of prevention and control of tuberculosisTherefore,in order to further reduce the hazards of tuberculosis and accelerate the construction of Healthy China,Chinese government and health-related administrative departments formulated the 13th Five-Year Plan for Tuberculosis Prevention and Control to guide the prevention and control of tuberculosis in China.However,the difficulty of achieving the expected objectives in different regions,and the epidemic related factors and social determinants affecting the realization of pulmonary tuberculosis control objectives are still unclear.ObjectiveThis study takes national average incidence rate of PTB—one of the objectives set in the 13th Five-Year Plan for Tuberculosis Prevention and Control—as the expected level to evaluate the gap between the current PTB incidence rate and the objective in different regions and provinces and expects to reveal the main indicators available for intervention and focal points through the analysis of epidemic related factors and social determinants affecting the realization of PTB control objectives,so as to provide technical support for PTB prevention and control practices.The standardized incidence ratio of PTB was built based on the actual and expected incidence rate of PTB and used to measure the relative gap between the actual incidence rate and the objective in a district or county.Univariate analysis was used for the comparison of the standardized incidence ratio in different regions and different provinces.Referring to the literature on the social determinants of PTB incidence and epidemic situation at home and abroad,considering the availability of data,the relevant indicators were selected and determined as independent variables,the standardized incidence ratio as the dependent variable.Two-level multivariate variance component model was used to assess the epidemic related indicators and social determinants related indicators affecting the realization of PTB planning objective.ResultsBy the end of 2016,59.48%(342/575)of the 575 districts and counties included in this study had met the requirement of the average incidence rate of PTB in the 13th Five-Year Plan,but certain gap still existed in some districts and counties.The control effects of PTB among different regions and different provinces were unbalanced.The median standardized incidence ratio of PTB in 2016 is 0.717(eastern region),0.936(northeastern region),0.974(western region)and 1.002(central region),respectively.The result showed that the gap between actual incidence rate and the objective in eastern region was superior to that in western region and the standardized incidence ratio in the county with the worst control effect was 72.02(10.277/0.142)times higher than that of the county with the best control effect.Within each region,the imbalance still existed.The standardized incidence ratio of tuberculosis among different regions has statistical significance(P<0.05).The epidemic and social determinants related indicators affecting the achievement of PTB control objectives were analyzed by two-level multivariate stochastic intercept model,and the results showed that the proportion of symptomatic patients(?=0.03848,P=0.002),the proportion of PTB patients with negative etiological examination results(61.70%?75.12%:?=0.09262,P=0.003;>75.12%:?=0.11230,P=0.003),the proportion of 0-to 14-year-old population(?=0.03876,P=0.015)were positively correlated with the standardized incidence ratios(SIR),while the Human Development Index(?=-0.07155,P=0.004)was negatively correlated with the SIR.ConclusionIn 2016.there was still a certain gap between the incidence rate of PTB and the planning objective and imbalance of the control effects of PTB in different regions and different provinces and within regions.Based on the current situation of PTB prevention and control and regional development in China,the exploration of the factors affecting the prevention and internal difference of PTB,a new mode of active detection for PTB patients using new technologies,giving full play to the radiation effect of regional medical centers,consolidation of the achievements of the former measures for prevention and control are recommended.Early detection and diagnosis of potential tuberculosis patients and enhancement of residents' health awareness and willingness to physical examination and clinical visit may help to control the epidemic of pulmonary tuberculosis.