Dissecting regional variability in Pyrazinamide prescribing practices for tuberculosis treatment in Japan

IF 1.9 Q3 INFECTIOUS DISEASES

Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Pub Date : 2024-11-22 DOI:10.1016/j.jctube.2024.100497

Nobuaki Kobayashi, Hiromi Matsumoto, Takeshi Kaneko

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引用次数: 0

Abstract

Objectives

To investigate regional variations in pyrazinamide (PZA) prescribing across Japan’s 47 prefectures and associated influential factors.

Methods

This study utilized the Standardized Claim Ratio (SCR) for PZA from Japan’s National Database of Health Insurance Claims in 2018. Pearson’s correlation coefficients assessed relationships between SCR and tuberculosis (TB) incidence, patient characteristics (age, liver disease), and healthcare resources (specialists, TB beds). Multiple regression analysis identified independent predictors of SCR.

Results

Median SCR for PZA was 90.0 (range 40.2–187.1), with a 3-fold difference between top and bottom prefectures. In univariate analysis, SCR correlated positively with TB incidence (r = 0.42), respiratory/infectious disease/TB specialists, and negatively with elderly TB patients (r = -0.33) and liver disease per TB case. Multiple regression revealed higher SCR associated with higher TB incidence (β = 0.44, p < 0.001), lower elderly patients (β = -0.33, p = 0.005), and more respiratory specialists (β = 0.41, p < 0.001).

Conclusions

Regional PZA prescription patterns are multifaceted, significantly influenced by TB prevalence, elderly patient ratios, and the availability of respiratory specialists. To enhance PZA prescribing conformity and TB management, fostering respiratory expertise across Japan is imperative.

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剖析日本肺结核治疗中吡嗪酰胺处方做法的地区差异

目标调查日本 47 个都道府县吡嗪酰胺（PZA）处方的地区差异及相关影响因素。方法本研究利用 2018 年日本全国健康保险索赔数据库中的 PZA 标准化索赔率（SCR）。皮尔逊相关系数评估了 SCR 与结核病（TB）发病率、患者特征（年龄、肝病）和医疗资源（专家、结核病床）之间的关系。多元回归分析确定了 SCR 的独立预测因素。结果PZA 的中位 SCR 为 90.0（范围为 40.2-187.1），最高和最低县之间相差 3 倍。在单变量分析中，SCR 与肺结核发病率（r = 0.42）、呼吸道/传染病/肺结核专家呈正相关，而与老年肺结核患者（r = -0.33）和每例肺结核患者的肝病呈负相关。多元回归显示，较高的 SCR 与较高的肺结核发病率（β = 0.44，p < 0.001）、较低的老年患者（β = -0.33，p = 0.005）和较多的呼吸科专家（β = 0.41，p < 0.001）相关。为了提高 PZA 处方的一致性和结核病管理水平，在日本全国范围内培养呼吸科专家势在必行。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Medicine-Pulmonary and Respiratory Medicine

CiteScore

4.00

自引率

5.00%

发文量

审稿时长

30 weeks

期刊介绍： Journal of Clinical Tuberculosis and Mycobacterial Diseases aims to provide a forum for clinically relevant articles on all aspects of tuberculosis and other mycobacterial infections, including (but not limited to) epidemiology, clinical investigation, transmission, diagnosis, treatment, drug-resistance and public policy, and encourages the submission of clinical studies, thematic reviews and case reports. Journal of Clinical Tuberculosis and Mycobacterial Diseases is an Open Access publication.