Prevalence and risk factors of active pulmonary tuberculosis among elderly people in China: a population based cross-sectional study

Zhang, Canyou; Zhao, Fei; Xia, Yuqing; Yu, Yongfu; Shen, Xin; Lü, Wei; Wang, Xiaomeng; Jin, Xing; Ye, Jianjun; Li, Jianwei; Liu, Fei-Ying; Wu, Jianlin; Xu, Lin; Zhang, Hui; Cheng, Jun; Wang, Lixia

doi:10.1186/s40249-019-0515-y

Cited by 33 publications

(28 citation statements)

References 34 publications

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“…We conducted a prevalence survey in selected sites from July to September in 2013, to establish an elderly cohort without TB. The study sites selection and diagnostic algorithm in that prevalence survey has been described fully elsewhere [17]. In brief, the study adopted a three-stage cluster and random sampling for selecting study sites (Fig.…”

Section: Cohort Establishment From Tb Prevalence Survey In 2013mentioning

confidence: 99%

Incidence and risk factors of tuberculosis among the elderly population in China: a prospective cohort study

Cheng

Sun²,

Zhang

et al. 2020

Infect Dis Poverty

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Background: China is facing challenges of the shifting presentation of tuberculosis (TB) from younger to elderly due to an ageing population, longer life expectancy and reactivation disease. However, the burden of elderly TB and influence factors are not yet clear. To fill the gap, we generated a cohort study to measure the magnitude of TB incidence and associated factors among the elderly population aged 65 years and above in China. Methods: In this cohort established in 2013 through a prevalence survey conducted in selected sites, a total of 34 076 elderlies without TB were enrolled into two-year follow-up. We used both active and passive case findings to find out all TB patients among them. The person-year (PY) incidence rates for both bacteriologically positive TB and active TB were calculated. Cox proportional regression model was performed to test effect of risk factors, and the population attributable fraction (PAF) of each risk factor contributing to incident TB among elderlies was calculated. Results: Over the two-year follow-up period, a total of 215 incident active TB were identified, 62 of which were bacteriologically positive. The incidence rates for active TB and bacteriologically positive TB were 481.8 per 100 000 PY (95% CI: 417.4-546.2 per 100 000 PY) and 138.9 per 100 000 PY (95% CI: 104.4-173.5 per 100 000 PY), respectively. Incident cases detected by active case finding were significantly higher (P < 0.001). Male, non-Han nationality, previously treated TB, ex/current smoker and body mass index (BMI) < 18.5 presented as independent predictors for developing TB disease. For developing bacteriologically positive TB, the biggest contribution was from self-reported ex or current smoker (18.06%). And, for developing active TB, the biggest contribution was from non-Han nationality (35.40%), followed by male (26.80%) and age at 75 years and above (10.85%). Conclusions: Ageing population in China had a high TB incidence rate and risk to develop TB disease, implying that National TB Program (NTP) needs to prioritize for elderly. Active case finding should be applied capture more active TB cases among this particular population, especially for male, non-Han nationality, and those with identified risk factors.

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Section: Cohort Establishment From Tb Prevalence Survey In 2013mentioning

confidence: 99%

Incidence and risk factors of tuberculosis among the elderly population in China: a prospective cohort study

Cheng

Sun²,

Zhang

et al. 2020

Infect Dis Poverty

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“…It means that we should put our sights on primary tuberculosis among the elderly, especially DR-TB, to face the problem which the aging population will bring. Previous studies on elderly TB in China showed that an aging population had a higher TB incidence rate and risk to develop TB disease, [11][12][13] Nevertheless, the studies on DR-TB in the elderly are few. Therefore, we investigated epidemiological characteristics and trend of primary DR-TB among the elderly in this study.…”

Section: Introductionmentioning

confidence: 99%

<p>Primary Drug-Resistance Pattern and Trend in Elderly Tuberculosis Patients in Shandong, China, from 2004 to 2019</p>

An¹,

Song²,

Liu³

et al. 2020

IDR

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“…Population-based observational studies revealed that lower BMI was related to tuberculosis. Researches of the crosssectional prevalence investigation and followed up cohort among elderly in China, Zhang et al and Cheng et al [10,11] reported that a signi cantly higher risk or hazard of tuberculosis in the underweight group (adjusted odds ratio [aOR], 1.55; 95% CI, 1.09-2.22) and (aHR, 2.33; 95% CI 1.32-4.12) respectively, compared with normal-weight among those age over 65 years in China. However, our study reported a non-signi cant association for underweight and tuberculosis in general adult and elderly sub-population.…”

Section: Discussionmentioning

confidence: 99%

Body mass index and its dose-response relationship with the incidence and risk of tuberculosis, a population-based cohort study

Chen

Zha

Hou

et al. 2020

Preprint

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Background Many pieces of evidence presented the body mass index (BMI) was inversely associated with tuberculosis (TB). BMI was radically changed during the past decades in China. The aim of the study was to evaluate the contemporary relationship between BMI and tuberculosis incident. Methods A population-based prospective cohort included 26 022 community participants was conducted. Three rounds of tuberculosis screening were implemented between June 2013 and December 2015. The main exposure was defined as baseline BMI, and was categorized into 3 levels: underweight (< 18.5 kg/m2), normal (18.5 to 24.0 kg/m2), overweight or obese (≥ 24.0 kg/m2). The active tuberculosis incident in the second or third round screening was the study outcome. The dose-response relationship between BMI and tuberculosis incidence as well as tuberculosis risk were analyzed. Results During the followed up of 2.25 years, 43 cases developed tuberculosis in 44 574.4 person-years. The log-linear dose-response relationship between BMI and tuberculosis incidence was fitted (adjusted R2 = 0.95). In multivariable Cox proportional regression, overweight and obese was associated with a lower risk of incident tuberculosis compared with normal weight (adjusted hazard ratio [aHR], 0.34; 95% confidence interval [CI] 0.14–0.82, p < 0.01), the inverse dose-response association between BMI and tuberculosis risk was characterized by restricted cubic spline. In subgroups analysis, the risk of tuberculosis reduced 78% in overweight or obese (aHR, 0.22; 95% CI 0.05–0.97, p = 0.05) and 64% (aHR, 0.36; 95% CI 0.12-1.00, p = 0.05) compared with normal weight among female and elderly. Conclusion Our study revealed that high BMI was a protective factor in tuberculosis development. Precise dose-response relationship between BMI and the incident tuberculosis, as well as the risk of tuberculosis progression in contemporary Chinese adulthood, will benefit to disease control policy.

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Prevalence and risk factors of active pulmonary tuberculosis among elderly people in China: a population based cross-sectional study

Cited by 33 publications

References 34 publications

Incidence and risk factors of tuberculosis among the elderly population in China: a prospective cohort study

Incidence and risk factors of tuberculosis among the elderly population in China: a prospective cohort study

<p>Primary Drug-Resistance Pattern and Trend in Elderly Tuberculosis Patients in Shandong, China, from 2004 to 2019</p>

Body mass index and its dose-response relationship with the incidence and risk of tuberculosis, a population-based cohort study

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