Spatial analysis of tuberculosis treatment outcomes in Shanghai: implications for tuberculosis control

Zhang Jing; Shen Xin; Yang Chongguang; Chen Yue; Guo Juntao; Wang Decheng; Zhang Jun; Lynn Henry; Hu Yi; Pan Qichao; Zhang Zhijie

doi:10.4178/epih.e2022045

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자료유형: 학술저널

저자정보: Zhang Jing (Department of Epidemiology and Biostatistics School of Public Health Fudan University) Shen Xin (Division of TB and HIV/AIDS Prevention Shanghai Municipal Center for Disease Control and Prevention) Yang Chongguang (Department of Epidemiology of Microbial Diseases School of Public Health Yale University) Chen Yue (School of Epidemiology Public Health and Preventive Medicine Faculty of Medicine University of Otta) Guo Juntao (Division of TB and HIV/AIDS Prevention Shanghai Municipal Center for Disease Control and Prevention) Wang Decheng (Medical Science College China Three Gorges University) Zhang Jun (Department of Epidemiology and Biostatistics School of Public Health Fudan University) Lynn Henry (Department of Epidemiology and Biostatistics School of Public Health Fudan University) Hu Yi (Department of Epidemiology and Biostatistics School of Public Health Fudan University) Pan Qichao (Division of TB and HIV/AIDS Prevention Shanghai Municipal Center for Disease Control and Prevention) Zhang Zhijie (Department of Epidemiology and Biostatistics School of Public Health Fudan University)

저널정보: 한국역학회 Epidemiology and Health Epidemiology and Health Vol.44

발행연도: 2022.1

수록면: 1 - 11 (11page)

DOI: 10.4178/epih.e2022045

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OBJECTIVES: Tuberculosis (TB) treatment outcomes are a key indicator in the assessment of TB control programs. We aimed to identify spatial factors associated with TB treatment outcomes, and to provide additional insights into TB control from a geographical perspective.METHODS: We collected data from the electronic TB surveillance system in Shanghai, China and included pulmonary TB patients registered from January 1, 2009 to December 31, 2016. We examined the associations of physical accessibility to hospitals, an autoregression term, and random hospital effects with treatment outcomes in logistic regression models after adjusting for demographic, clinical, and treatment factors.RESULTS: Of the 53,475 pulmonary TB patients, 49,002 (91.6%) had successful treatment outcomes. The success rate increased from 89.3% in 2009 to 94.4% in 2016. The successful treatment outcome rate varied among hospitals from 78.6% to 97.8%, and there were 12 spatial clusters of poor treatment outcomes during the 8-year study period. The best-fit model incorporated spatial factors. Both the random hospital effects and autoregression terms had significant impacts on TB treatment outcomes, ranking 6th and 10th, respectively, in terms of statistical importance among 14 factors. The number of bus stations around the home was the least important variable in the model.CONCLUSIONS: Spatial autocorrelation and hospital effects were associated with TB treatment outcomes in Shanghai. In highly-integrated cities like Shanghai, physical accessibility was not related to treatment outcomes. Governments need to pay more attention to the mobility of patients and different success rates of treatment among hospitals.

#Tuberculosis #Treatment outcome #Spatial analysis #Hospital effect #Physical accessibility #China

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