1950-1963 年苏格兰格拉斯哥通过大规模胸部 X 光筛查主动发现结核病例的影响:对历史数据的流行病学分析。

IF 15.8 1区 医学 Q1 Medicine
PLoS Medicine Pub Date : 2024-11-05 eCollection Date: 2024-11-01 DOI:10.1371/journal.pmed.1004448
Peter MacPherson, Helen R Stagg, Alvaro Schwalb, Hazel Henderson, Alice E Taylor, Rachael M Burke, Hannah M Rickman, Cecily Miller, Rein M G J Houben, Peter J Dodd, Elizabeth L Corbett
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引用次数: 0

摘要

背景:1940年至1970年间,欧洲和北美广泛开展了结核病社区主动病例发现(ACF)活动,当时的发病率与当今许多高负担国家相当。我们采用间断时间序列分析法,分析了 1957 年格拉斯哥大规模胸部 X 光检查活动的影响,为当代的筛查方法提供参考:我们从公共卫生记录中提取了 1950 年至 1963 年的病例通知,并将其与人口统计学数据联系起来。我们建立了贝叶斯多层次回归模型,以估算 1957 年实施为期 5 周的大规模筛查干预期间和之后的年度相对病例通报率 (CNR),并与未实施干预的反事实情况进行比较。我们还估算了病例检出率和发病率。从 1957 年 3 月 11 日到 1957 年 4 月 12 日,714,915 人(819,301 名年龄≥15 岁的成年居民中的 622,349 人[76.0%])接受了微型胸部 X 光筛查;2,369 人(0.4%)被确诊为肺结核。干预前(1950 年至 1956 年),肺病 CNR 从 1950 年的 222/100,000 逐年下降 2.3%。1957 年进行干预后,肺部 CNR 翻了一番(RR:1.95,95% 不确定区间 [UI] [1.81,2.11]),之后一年下降了 35%(RR:0.65,95% UI [0.59,0.71])。干预后(1958 年至 1963 年)的年下降率(每年 5.4%)更高(RR:0.77,95% UI [0.69,0.85]),估计干预后可避免 4599 例(95% UI [3641,5683])肺部病例通知。干预措施对所有城市病房的影响是一致的,幼儿(0 到 5 岁)的肺部病例报告数也有所下降。不足之处包括:历史报告中缺乏结核病微生物检测数据,以及当时其他干预措施(包括贫民窟清理、卡介苗接种计划的引入以及战后食品配给的结束)所产生的促进作用的不确定性:单轮快速的胸部 X 光大规模筛查(可能是有史以来规模最大的一次)很可能导致结核病病例通报的大幅持续减少。需要对其他历史性结核病筛查计划的证据进行综合分析,以证实格拉斯哥的研究结果,并为当前在结核病高负担国家利用新的筛查工具和技术成功实施 ACF 干预措施的努力提供启示。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of active case finding for tuberculosis with mass chest X-ray screening in Glasgow, Scotland, 1950-1963: An epidemiological analysis of historical data.

Background: Community active case finding (ACF) for tuberculosis was widely implemented in Europe and North America between 1940 and 1970, when incidence was comparable to many present-day high-burden countries. Using an interrupted time series analysis, we analysed the effect of the 1957 Glasgow mass chest X-ray campaign to inform contemporary approaches to screening.

Methods and findings: Case notifications for 1950 to 1963 were extracted from public health records and linked to demographic data. We fitted Bayesian multilevel regression models to estimate annual relative case notification rates (CNRs) during and after a mass screening intervention implemented over 5 weeks in 1957 compared to the counterfactual scenario where the intervention had not occurred. We additionally estimated case detection ratios and incidence. From 11 March 1957 to 12 April 1957, 714,915 people (622,349 of 819,301 [76.0%] resident adults ≥15 years) were screened with miniature chest X-ray; 2,369 (0.4%) were diagnosed with tuberculosis. Pre-intervention (1950 to 1956), pulmonary CNRs were declining at 2.3% per year from a CNR of 222/100,000 in 1950. With the intervention in 1957, there was a doubling in the pulmonary CNR (RR: 1.95, 95% uncertainty interval [UI] [1.81, 2.11]) and 35% decline in the year after (RR: 0.65, 95% UI [0.59, 0.71]). Post-intervention (1958 to 1963) annual rates of decline (5.4% per year) were greater (RR: 0.77, 95% UI [0.69, 0.85]), and there were an estimated 4,599 (95% UI [3,641, 5,683]) pulmonary case notifications averted due to the intervention. Effects were consistent across all city wards and notifications declined in young children (0 to 5 years) with the intervention. Limitations include the lack of data in historical reports on microbiological testing for tuberculosis, and uncertainty in contributory effects of other contemporaneous interventions including slum clearances, introduction of BCG vaccination programmes, and the ending of postwar food rationing.

Conclusions: A single, rapid round of mass screening with chest X-ray (probably the largest ever conducted) likely resulted in a major and sustained reduction in tuberculosis case notifications. Synthesis of evidence from other historical tuberculosis screening programmes is needed to confirm findings from Glasgow and to provide insights into ongoing efforts to successfully implement ACF interventions in today's high tuberculosis burden countries and with new screening tools and technologies.

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来源期刊
PLoS Medicine
PLoS Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
17.60
自引率
0.60%
发文量
227
审稿时长
4-8 weeks
期刊介绍: PLOS Medicine is a prominent platform for discussing and researching global health challenges. The journal covers a wide range of topics, including biomedical, environmental, social, and political factors affecting health. It prioritizes articles that contribute to clinical practice, health policy, or a better understanding of pathophysiology, ultimately aiming to improve health outcomes across different settings. The journal is unwavering in its commitment to uphold the highest ethical standards in medical publishing. This includes actively managing and disclosing any conflicts of interest related to reporting, reviewing, and publishing. PLOS Medicine promotes transparency in the entire review and publication process. The journal also encourages data sharing and encourages the reuse of published work. Additionally, authors retain copyright for their work, and the publication is made accessible through Open Access with no restrictions on availability and dissemination. PLOS Medicine takes measures to avoid conflicts of interest associated with advertising drugs and medical devices or engaging in the exclusive sale of reprints.
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