探討2005-2006年彰化地區新診斷結核病高死亡率原因

Investigation of the Causes of High Tuberculosis Death in Changhua County Between 2005-2006

目的：結核病是由空氣傳染的感染疾病。在許多高盛行率的國家，結核病持續是一個重大公衛問題。從「台灣結核病防治年報」，台灣的肺結核死亡人數有明顯的下降，但是在2005至2006年間彰化地區卻未有減緩。此研究目的為探討2005至2006年間彰化地區結核病高死亡率之原因。方法：納入從2005年1月至2006年12月間肺結核通報確診且死亡之個案。分析個案病歷及相關之變項找出主要影響結核病患死亡原因。結果：從1,872通報結核病個案，442 （23.6%）人納入此研究分析。研究發現， 在彰化地區結核病患年齡層有顯著的比台灣其他地區高（p值<0.001），80%以上年齡高於70歲，並有達到顯著差異。另外，有24%的個案接受結核藥物治療前就死亡，顯示了延遲通報和診斷。此外大多數的個案（59.1%）都有一種以上的合併症，是導病患死亡的主要原因而非結核病。結論：在2005至2006年間，高年齡層、合併症和延誤診斷與彰化地區結核病高死亡有關。

Objectives. Tuberculosis (TB), an airborne infectious disease, remains a major issue in countries with high TB prevalence. According to the “Taiwan Tuberculosis Control Report,” the number of people who died from tuberculosis significantly decrease in all areas of Taiwan except Changhua County between 2005 and 2006. The aim of the study was to investigate the causes of the high death rate due to tuberculosis in Changhua County. Methods. Medical records of people who had confirmed tuberculosis and had died between January 2005 and December 2006 were reviewed and related variables were analyzed to identify the main factors contributing to the death during tuberculosis treatment. Results. From a total of 1, 872 registered tuberculosis patients, 442 (23.6%) died and were included in this study. The age of tuberculosis patients in Changhua County was significantly higher than in other districts in Taiwan (p value < 0.001), with more than 80% of the TB deaths occurring in patients who were older than 70 years old. Moreover, twentyfour percent of the subjects died before TB treatment indicating a delay in case notification and diagnosis. The majority of subjects (59.1%) had at least one or more co-morbidities which led to more fatalities than tuberculosis, itself. Conclusion. Old age, comorbidities and delay in diagnosis were associated to higher death rates in patients during tuberculosis treatment in Changhua County between 2005 and 2006.