2006-2013年圣保罗市结核病流行病学概况外文翻译资料

2006-2013年圣保罗市结核病流行病学概况

Priscila Fernanda Porto Scaff Pinto

圣保罗圣卡萨医学科学学院-圣保罗(SP)，巴西

摘要：背景 结核病是一个严重的公共卫生问题，在世界和巴西仍然存在。圣保罗市是巴西结核病控制的重要城市之一。目的 描述圣保罗市2006-2013年所有报告新发结核病的流行病学特征。方法 本研究选择的变量是从结核病在线信息系统获取社会经济学、人口学、临床流行病学数据资料。采用描述流行病学方法进行分析，进行年份间的比较，对历史序列进行线性趋势分析。结果与讨论 15岁以下儿童和流动人口的结核病发病率有所增加。随着督导治疗完善和初级保健诊所诊断病例比例的提高，结核病治愈率有所提高。结核病在圣保罗市内发病情况分布不均，有些地区结核病未能得到有效控制。结论 圣保罗市结核病控制规划需要针对城市的易感人群和发病率较高的地区。

关键词：结核病；流行病学；公共卫生；健康评估；流行病学监测；大城市

尽管结核病是可以预防和治愈的，但它仍是全球公共卫生面临的严重威胁之一，是导致传染病死亡的第二大原因。在巴西，结核病发病与易感人群、贫困和高人口密度城市相关。圣保罗市是结核病控制的重点城市之一，主要原因是圣保罗市是一个存在着社会不平等的大城市，该市有重要一部分流动人口，难以获得公共卫生服务保障，结核病难以得到有效控制。考虑到结核病在圣保罗市的流行状况，以及该疾病相关公共卫生和卫生服务效率指标等，本研究目的是描述圣保罗市2006-2013年报告的所有新结核病例的流行病学概况。

1 对象与方法

1.1 对象 2006-2013年居住在圣保罗市并在此期间报告的新发结核病例。新发病例定义为：未接受过抗结核治疗或抗结核治疗不足30天的结核病患者。排除病例标准：诊断变更或被拘留患者病例。

1.2 数据 圣保罗市自2006年起启用结核病在线信息系统，故数据选取为2006-2013年系统新登记的结核病例相关资料。数据已获得流行病学监测中心和结核病控制小组的授权和圣保罗市圣卡萨医学院公共卫生系科学委员会的批准，且作者与研究对象之间不存在利益冲突。

1.3 方法 本文研究的变量是基于圣保罗州发布的结核病报告项目标准，即：性别、年龄、种族/肤色、地址类型、疾病类型、检测项目类型、诊断类型和治疗结果。计算结核病发病率（发病率/10万/年）使用的人口数据摘自国家数据网络系统（SEADE），采用EpiInfo 7软件进行频率分析、线性趋势分析、卡方检验和95%置信区间分析，以P＜0.05为差异有统计学意义。空间分布方面，利用代码软件QGis编制2006年、2010年和2013年各行政区结核病发病率分布地图。

2 结果

本文研究期间，圣保罗市结核病发病率从2006年52.6/10万变化至2013年49.5/10万，不同年份的发病率差异无统计学意义（P=0.078）（见图1）。

图1.圣保罗市2006-2013年结核病年发病情况

男性结核病年发病率无明显波动（P=0.267），2013年男性结核病发病率为女性的2.03倍（95%CI：1.98-2.06）（见图2）。从年龄层面看，0-14岁儿童的年发病率呈上升趋势（P=0.007），而15-59岁年龄组（P=0.022）和60岁及以上年龄组呈下降趋势（P=0.047）（见图3）。结核病患者中流动人口比例从2006年的2.7%上升到2013年的5.5%（P＜0.001）。

图2.圣保罗市2006-2013年男女结核病年发病情况

图3. 圣保罗市2006-2013年不同年龄组的结核病年发病情况

表1. 圣保罗市2006年和2013年结核病患者临床比较

*合计排除了数据空缺的病例；**痰涂片显微镜检查只针对15岁以上的患者；***胸部X线检查只针对肺结核患者；****由于2006年治疗类型数据大量丢失，故未进行统计检验。

图4. 圣保罗市2006、2010和2013年不同行政区结核病发病分布情况

2010年，土著居民是圣保罗市结核病年发病率最高的人群，为724.9/10万。与白人年发病率相比，土著居民患结核病的相对危险度为19.0（95%CI：15.5-23.4）。黑人结核病年发病率也较高，为87.0/10万。

肺的临床表现为结核病的主要临床特征。本文研究期间，初级保健诊断（门诊需求和主动搜索/接触调查）比例和治愈率都有很大的提高。胸部X线检查需求减少，而人类免疫缺陷病毒（HIV）检测增加。督导治疗范围扩大，2013年结核病60.5%（95%CI：59.2-61.7）的结

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Epidemiological profile of tuberculosis in Sao Paulo municipality from 2006 to 2013

Priscila Fernanda Porto Scaff Pinto¹,Cassio Silveira¹,Maria Josefa Penon Rujula¹, Francisco Chiaravalloti Neto¹¹,Manoel Carlos Sampaio de Almeida Ribeira¹

ABSTRACT: Background: Tuberculosis is a serious public health problem that still persists in the world and in Brazil. The municipality of Sao Paulo, Brazil, is among the prioritized ones in the country for disease control. Objective: To describe the epidemiological profile of all new tuberculosis cases in Sao Paulo municipality reported between the years 2006 and 2013. Methods: The variables selected for the study were: socioeconomic, demographic and clinical-epidemiologic obtained through the online information system TB-WEB. A descriptive analysis of the data was performed to undertake the comparison among the years. To study the historical series, linear trend analysis was held. Results and discussion: There was an increase in the tuberculosis incidence rate in children under 15 years and in homeless people. The cure rate has improved as the proportion of completion of supervised treatment and the proportion of cases diagnosed by primary care clinics. The disease is unevenly distributed within the municipality of Sao Paulo and there are districts that were not able to improve the tuberculosis control. Conclusion: The municipal tuberculosis program control needs to target the vulnerable groups and the regions of the city where the incidence rates are higher.

Keywords: Tuberculosis. Epidemiology. Public health. Health evaluation. Epidemiological surveillance. Large cities.

INTRODUCTION

Despite being preventable and curable, tuberculosis (TB) remains one of the most serious threats to global public health, being the second leading cause of death among infectious diseases¹.

In Brazil, the disease is associated with vulnerable populations, poverty and agglomerated urban areas with high population density².

The municipality of Sao Paulo, a priority for the control of TB³, is a large metropolis permeated by social inequalities, where an important part of the population is inserted in the urban space in a precarious way and difficult access to public goods⁴.

Considering the relevance of TB in the MSP, and that the disease acts as an indicator of public health and the efficiency of health services⁵, the objective of this study was to describe the epidemiological profile of all new TB cases reported between 2006 and 2013.

METHODS

Descriptive epidemiological study carried out in the MSP between the years of 2006 and 2013. All new TB cases residing in the municipality and reported within the period were included in the analysis. The definition for a new case was considered to be a patient who was diagnosed with the disease and that had never undergone anti-TB treatment, or had done so for up to 30 days⁶. Patients with a change of diagnosis and detainees were excluded.

The data were extracted from the TB-WEB, an online information system of the state of Sao Paulo (SSP) that stores the records of the TB notification form. The year 2006 was chosen as the initial year since it was the definitive implementation of this system.

Access to secondary data was possible after authorization from the Tuberculosis Control Group of the Center for Epidemiological Surveillance (CES) and approval of the Scientific Committee of the Department of Collective Health of the School of Medical Sciences of Santa Casa de Sao Paulo. There is no conflict of interests of the authors in relation to the subject studied.

The variables used in the study were based on the items of the TB notification form standardized by CES of the SSP namely: sex, age, race/color, type of address, disease classification, type of treatment, tests performed, type of discovery and outcome situation.

The incidence rates of TB per 100,000 inhabitants/year were calculated using the population extracted from the Foundation State System of Data Analysis (SEADE) website.

Epilnfo 7 was used for frequency analysis, linear trend test, c² test, and 95% confidence interval (95%CI). A statistical significance level of 0.05 was established.

Regarding to the spatial distribution, thematic maps were prepared with the annual TB incidence rate by administrative district for the years 2006, 2010 and 2013 using the free code software QGis.

RESULTS

In the study period, the incidence rate of TB per 100,000 inhabitants/year went from 52.6 in 2006 to 49.5 in 2013 (Graph 1); however, the reduction was not statistically significant (p = 0.078).

The annual incidence rate of the disease among men seems to remain stable (p = 0.267) (Graph 2), and in 2013 it was 2.03 times higher than that of women (95%CI 1.98 - 2.06). There was a trend towards an increase in the annual incidence of TB among children aged 0 to 14 years (p = 0.007), and a tendency of reduction in the age groups of 15 to 59 years (p = 0.022) and 60 years and over (p = 0.047) (Graph 3). The proportion of TB patients without fixed residence increased from 2.7% in 2006 to 5.5% in 2013 (p lt; 0.001).

Indigenous people represented the highest annual TB incidence rate in the MSP in 2010, being 724.9 cases per 100,000 inhabitants/year, representing a relative risk of 19.0 (95%CI 15.5 - 23.4) when compared to the annual incidence rate in white people. Black people also had a high annual incidence rate: 87.0 per 100,000 inhabitants/year.

The pulmonary clinical form remained predominant. There was a greater targeting of the diagnoses for Primary Care (outpatient d

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