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2016—2022年重庆市肺结核合并糖尿病人群特征、发病趋势及治疗转归

Characteristics, incidence trends, and treatment outcomes of tuberculosis patients with diabetes in Chongqing city from 2016 to 2022: an analysis of registration data

    摘要
  • 摘要:
    目的 了解重庆市肺结核合并糖尿病（PTB-DM）的流行趋势及防治影响因素，为降低当地共病风险和改善患者转归提供依据。
    方法 从全国结核病信息管理系统中导出2016—2022重庆市登记的PTB-DM患者病案资料，对发病趋势及人群特征进行描述性分析，采用χ2检验进行组间比较，采用多因素非条件 logistic 回归分析患者治疗转归的影响因素，应用Joinpoint回归模型分析发病趋势。
    结果 2016—2022 年重庆市PTB患者平均登记率为49.38/10万，登记率呈下降趋势（AAPC=−10.70%，95%CI=−16.16%～−5.63%）。PTB-DM患者平均登记率为2.9/10万，登记率呈上升趋势（AAPC=14.38%，95%CI=7.08%～23.73%）。患者主要以男性、老年人群、转诊、延误就诊、病原学结果阳性等特征为主。PTB-DM患者的转归情况中，成功治疗占80.85 %，不良结局占19.15 %，年平均成功治疗率为82.01%，Joinpoint 回归分析显示患者成功治疗率呈下降趋势。非条件多因素 logistic 回归分析结果显示，少数民族（OR=0.744，95%CI=0.633～0.874）、0～24岁年龄组（OR=0.217，95%CI=0.051～0.922）、25～39岁年龄组（OR=0.540，95%CI=0.398～0.734 ）、40～54岁年龄组（OR=0.488，95%CI=0.416～0.572）、55～64岁年龄组（OR=0.709，95%CI=0.607～0.828）、初治（OR=0.648，95%CI=0.531～0.791）、病原学阴性（OR=0.576，95%CI=0.489～0.677）是PTB-DM患者不良结局的保护因素 ；渝东南地区（OR=1.560，95%CI=1.218～1.999）、转诊（OR=1.289，95%CI=1.080～1.539 ）是PTB-DM患者不良结局的危险因素。
    结论 重庆市PTB-DM共病趋势明显，患者来源、延误就诊、管理方式等治疗及管理因素对患者治疗转归产生影响。

     

    Abstract:
    Objective To understand the epidemiologic trends and factors influencing the prevention and control of pulmonary tuberculosis with diabetes mellitus (PTB-DM) in Chongqing city, and to provide a basis for reducing the risk of comorbidities and improving patient outcomes in the region.
    Methods Data on PTB-DM patients registered in Chongqing city from 2016 to 2022 were extracted from the National Tuberculosis Information Management System. Descriptive analysis was used to analyze disease trends and demographic characteristics. Chi-square test was used to compare between groups. Multivariate unconditional logistic regression was used to analyze factors influencing patient outcomes. Joinpoint regression model was used to analyze disease trends.
    Results From 2016 to 2022, the average registration rate of PTB patients in Chongqing city was 49.38/100 000, with a decreasing trend (average annual percentage change AAPC= −10.70%, 95% confidence interval 95%CI: 16.16%–5.63%). The average registration rate of PTB-DM patients was 2.9/100 000, with an increasing trend (AAPC=14.38%, 95%CI: 7.08%–23.73%). Enrolled PTB-DM were predominantly male, older, referred, had delayed medical visits, and had positive pathogen detection results. Among the outcomes of PTB-DM patients, successful treatment accounted for 80.85% and adverse outcomes accounted for 19.15%. The average annual treatment success rate was 82.01%. Joinpoint regression analysis showed a decreasing trend in the patients′ treatment success rate. Multivariate unconditional logistic regression analysis showed that ethnic minorities (odds ratio OR=0.744, 95%CI: 0.633–0.874), 0–24 years old (OR=0.217, 95%CI: 0.051–0.922), 25–39 years old (OR=0.540, 95%CI: 0.398–0.734), 40–54 years old (OR=0.488, 95%CI: 0.416–0.572), 55–64 years old (OR=0.709, 95%CI: 0.607–0.828), initial treatment (OR=0.648, 95%CI: 0.531–0.791), and with negative pathogen detection results (OR=0.576, 95%CI: 0.489–0.677) were protective factors against adverse outcomes in PTB-DM patients. Living in southeast Chongqing (OR=1.560, 95%CI: 1.218–1.999) and being referred for treatment (OR=1.289, 95%CI: 1.080–1.539) were risk factors for adverse outcomes in PTB-DM patients.
    Conclusions The co-morbidity trend of PTB-DM in Chongqing city is obvious. Treatment and management factors, such as diagnostic route, delayed medical visits and management methods, have an impact on the treatment outcomes of PTB-DM patients.

     

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