COVID-19大流行與社會決定因素和結核病新案通報的相關性

Abstract

研究背景： COVID-19大流行嚴重影響了全球結核病的防治，導致新病例發生率下降。在臺灣，COVID-19 大流行的進展獨特，影響了居民的醫療利用和就醫行為，這可能導致新發結核病例的發生率出現變化。公眾配合預防措施或由於不願就醫而延誤診斷，可能會進一步影響結核病發生率下降。 研究目的： COVID-19大流行造成台北市結核病新病例發生率下降的真實原因及可能之危險因子值得更進一步研究。我們想探討COVID-19大流行是否會造成結核病發生率下降，居住地區社會之特性及並研究這些因素之間的相互作用。 研究方法： 本研究以 2020 年 1 月 COVID-19 大流行發生作為介入點，COVID-19 疫情發生前分為 2013-2015的「結核病十年減半」期和2016-2019 的「潛伏結核感染全都治計畫」期，COVID-19大流行發生後2020-2022 為「COVID-19 疫情」期。「COVID-19 大流行」期又分為2020 、2021、2022三階段。我們從傳染病統計資料查詢系統和疾病管制署資料開放平台下載結核病及COVID-19個案的通報資料日期、個案數、性別、年齡及行政區進行資料回溯性分析，並由臺北市統計資料庫查詢系統，查詢台北市的醫療服務量及公共運輸，行政區的人口、家庭經濟狀況(可支配所得高低差距倍數-五等分位)、教育程度專科以上比率、低收入戶比率、老年人口比率、原住民比率。藉由描述性統計來呈現樣本各個變項之分布情形，以平均數和標準差呈現各連續變項之分布，以次數及百分比呈現各類別變項之分布。以連接點回歸分析探討不同年間的結核病發生率的變化。 研究結果： 2013年至2022年間，台北市報告了 7,357例新發結核病病例，呈逐年下降趨勢。男性的發病率較高，並隨著年齡的增長而增加。臺北市的 COVID-19 病例從 2020 年的 195 例上升到 2021 年的 5,275例及 2022 年的 890,975 例。結核病新發病例的發病率從 2013 年的每十萬人口33.4人下降到 2022 年的 每十萬人口20.4人，在 COVID-19 大流行期間顯著下降。連接點回歸分析顯示，疫情前後大安、中正、大同、內湖、萬華等特定行政區的結核病新案發生率變化顯著。行政區的社會決定因素，包括教育程度、年齡、性別和家庭收入，與結核病新發病例顯著相關。在大流行期間，受教育程度較高、老年人口較少、男性比例較低和低收入家庭比率較低的行政區域結核病新發病例發生率下降幅度更大。 結論： COVID-19大流行導致台北結核病新案發生率下降，特別是在特定行政區。在大流行期間，社會決定因素在調節結核病發病率方面發揮著至關重要的作用。雖然新病例的減少可能與結核病延後被診斷出來有關，但需要進一步研究。

Background: The global tuberculosis (TB) control landscape has been significantly impacted by the COVID-19 pandemic, resulting in a decline in the incidence of new cases. In Taiwan, the COVID-19 pandemic has progressed uniquely, influencing residents'' medical utilization and healthcare-seeking behaviors, which may contribute to variations in the incidence of new tuberculosis cases. Public cooperation with prevention measures or delays in diagnosis due to a reluctance to seek medical care could further influence the reduction in new tuberculosis cases. Objective: This study aims to investigate the actual reasons behind the decline in TB new cases in Taipei City due to the COVID-19 pandemic. We seek to explore whether the pandemic contributes to delay of TB new cases, identify the social determinants influencing delay, and examine the interplay among these factors. Methods: In this study, the COVID-19 pandemic occurred in January 2020 as the intervention point. It spans three stages: stage A “Halving TB in 10 years program in Taiwan” from 2013 to 2015 and the stage B “The LTBI Treatment for All Contacts Program” from 2016 to 2019, and the stage C “COVID-19 pandemic” in 2020-2022 after the outbreak of COVID-19. Due to the severity of the pandemic, the impact of hospital operation reduction and policies, the COVID-19 pandemic is divided into three phases: 2020, 2021 and 2022. Data on TB and COVID-19 cases, including date, number, gender, age, and administrative region, were collected from the Infectious Disease Statistics Enquiry System and the CDC Open Data Platform. The analysis considers demographic factors and healthcare utilization data from the Taipei City Statistical Database Query System. Descriptive statistics and Joinpoint regression analysis were employed to explore changes in incidence of TB new cases. Results: Between 2013 and 2022, Taipei City reported 7,357 new tuberculosis cases, displaying a consistent yearly decrease. The incidence was higher in men and increased with age. COVID-19 cases in Taipei City rose from 195 cases in 2020 to 5,275 cases in 2021, and 890,975 cases in 2022. The incidence of TB new cases decreased from 33.4 per 100,000/year in 2013 to 20.4/100,000/year in 2022, with a notable decline during the COVID-19 pandemic. Joinpoint regression analysis revealed significant changes in incidence rates in specific administrative districts such as Daan, Zhongzheng, Datong, Neihu and Wanhua before and after the pandemic. The social determinants of administrative districts, including education, age, gender, and household income, correlated significantly with TB new cases. During the pandemic, administrative regions with higher education rates, lower elderly populations, lower male ratios, and lower rates of low-income households experienced a greater reduction in incidence of TB new cases. Conclusions: The COVID-19 pandemic has contributed to a decline in TB new cases in Taipei, particularly in specific administrative regions. Social determinants play a crucial role in regulating tuberculosis incidence during the pandemic. While the reduction in new cases may be linked to delayed TB diagnosis, further research is necessary to elucidate these relationships.