Abstract:

Objective: To analyze and compare the situation of tuberculosis (TB) case detection in key areas of Yunnan Province with other areas since the implementation of the 13th Five-Year Plan for National Tuberculosis Control and Prevention, and to provide a reference basis for the development of TB case-detection strategies and measures. Methods: The information of pulmonary TB patient notification, routine surveillance data and medical record information of TB patients registered for treatment in Yunnan Province from 2015 to 2022 were collected from the China Disease Control and Prevention Information System (CDCIS). The indicators on assessing TB case-detection work in 57 key districts/counties (27 national-level and 30 provincial-level counties for rural revitalization) and 72 other districts/counties were retrospectively evaluated, and the situation of TB case-detection were analyzed and compared. Results: Joinpoint regression (JPR) analysis showed that the reported incidence rates of TB in the key areas and other areas of Yunnan Province had a trend of “firstly rising and then declining” from 2015 to 2022. In the key areas, the rate was a significant increase from 2015 to 2020 (annual percentage change, APC=4.18, P=0.028) and an insignificant decline from 2020 to 2022 (APC=―6.28, P=0.247); in other areas, it was a period of insignificant increase (APC=5.12, P=0.097) from 2015 to 2017 and a period of significant decline (APC=―6.24, P=0.001) from 2017 to 2022. The reported incidence rate of pulmonary TB was 75.74 per 100000 (123980/163689089) in the key areas, higher than that in other areas (45.31 per 100000, 98587/217575588) with a statistically significant difference (t=2.564, P=0.010). The proportion of TB suspects who sought health care in the key areas was 4.72‰ (788137/167080059) among the total population, higher than that in other areas (3.86‰, 825392/213889708), the difference was statistically significant (χ²=16380.378, P<0.001). The incidence of delayed health care seeking in the key areas was 68.84% (77857/113102), which was higher than 57.58% (51287/89066) in other areas, the difference was statistically significant (χ²=2735.422, P<0.001). The etiological testing rate among TB suspected in the key areas was 72.99% (575241/788137), lower than that in other areas (78.11% (644706/825392)), the difference was statistically significant (χ²=5734.282, P<0.001). The etiological test positive rate was 41.78% (46673/111717) in the key areas, lower than that in other areas (45.45% (38887/85552)), the difference was statistically significant (χ²=266.613, P<0.001). Conclusion: Since the implementation of the 13th Five-Year Plan for National Tuberculosis Control and Prevention, the TB case detection in both key areas and other areas of Yunnan Province has been significantly improved. However, the efforts of case detection in the key areas are still insufficient. It needs to continue to adhere to the active screening strategy for detecting TB patients earlier, reducing the transmission of TB, and reducing the epidemic level of TB.

Key words: Tuberculosis, Health priorities, Communicable disease control, Yunnan Province