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首页> 外文会议>International conference on geographies of health and living in cities >Risk Factors of Treatment Outcomes for Multi-drug Resistant Tuberculosis in Shanghai, 2009-2012
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Risk Factors of Treatment Outcomes for Multi-drug Resistant Tuberculosis in Shanghai, 2009-2012

机译：2009 - 2012年上海多毒性结核治疗成果的危险因素

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Background: Multi-drug resistant tuberculosis (MDR-TB), defined as resistant to at least isoniazid and rifampicin, has imposed serious risks on public health globally. China has the largest number of MDR-TB patients, and a prevalence rate two times of the world average. The study investigated the association between MDR-TB treatment outcome and patient risk factors, including physical accessibility to TB hospitals. Methods: We collected all the 336 MDR-TB cases reported in Shanghai between 2009 and 2012 from Shanghai CDC regarding information on age, gender, resident status, treatment history, and outcomes. Using the Geographical Information System (GIS), TB hospitals and study subjects' locations were geocoded on digital maps. To identify the statistically significant geographical clusters, kernel density estimation (KDE) and Average Nearest Neighbor (ANN) index were used. Logistic regression analysis was employed to determine the association of spatial and non-spatial variables on the occurrence of poor treatment outcomes. Results: The spatial clusters of MDR-TB cases were concentrated in the most densely populated central urban areas. There was a tendency toward higher odds of poor treatment outcomes among aged>45 years old (aOR 3.251; 95%CI 1.527-7.21), residential (aOR 2.566; 95%CI 1.154-5.88), retreated (aOR 2.566; 95%CI 1.154-5.88) and sputum smear positive (aOR 3.286; 95%CI 1.154-11.66) MDR-TB cases. Both the straight-line distance and the road distance from a patient's home to the related TB hospital were significantly associated with poor treatment outcome with an odds ratio of 1.04 (95%CI 1.009-1.08) and 1.029 (95%CI 1.005-1.06) respectively. Conclusion: This study highlights the effect of spatial and non-spatial determinants of MDR-TB treatment outcome, particularly with regard to physical accessibility to the TB hospitals. Accordingly, non-spatial factors in terms of previous treated status need for more attention by public health policy makers, and then more focus should be placed on the health delivery system, particularly in elderly patients. In addition, using the GIS application with a view to MDR-TB distribution and physical accessibility to hospitals is a novel method in Shanghai and it can be developed to reach other related public health disciplines.
机译：背景：耐多药结核病（MDR-TB），定义为耐至少对异烟肼和利福平，已在全球强加给公众健康带来严重隐患。中国有MDR-TB患者数量最多，且患病率世界平均水平的两倍。这项研究调查了MDR-TB治疗效果和患者的风险因素，包括物理访问性结核病医院之间的关联。方法：我们收集了所有336 MDR-TB患者从上海疾病预防控制中心2009年至2012年间在报道有关上海的年龄信息，性别，居住情况，治疗史和结果。利用地理信息系统（GIS），结核病医院和研究课题的位置进行地理编码的数字地图。为了识别具有统计学显著地理集群，核密度估计（KDE）和平均最近邻（ANN）指数使用。 logistic回归分析用于确定空间和非空间变量对差治疗结果的发生的关联。结果：MDR-TB病例的空间簇集中在人口最稠密的中央城市地区。有朝中年龄> 45岁的可怜的治疗效果的几率越高的倾向（AOR 3.251; 95％CI 1.527-7.21），住宅（AOR 2.566; 95％CI 1.154-5.88），退（AOR 2.566; 95％CI 1.154-5.88）和痰涂片阳性（AOR 3.286; 95％CI 1.154-11.66）MDR-TB病例。无论是直线距离，并从患者家到相关TB医院路途远近与治疗效果较差，1.04（95％CI 1.009-1.08）和1.029（95％CI 1.005-1.06）的比值比分别显著相关分别。结论：这项研究强调MDR-TB治疗结果的空间和非空间因素，特别是关于物理可访问性的结核病医院的效果。因此，在以前已处理需要更多的关注方面非空间因素的公共卫生政策制定者，然后更多的重点应放在医疗卫生服务体系，特别是在老年患者。此外，使用GIS应用，以MDR-TB的分布和实际可获取到医院在上海的新方法，它可以开发出能实现其他相关的公共卫生学科。

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