Mass Tuberculosis Screening Among the Elderly: A Population-Based Study in a Well-Confined, Rural County in Eastern China

Author:

Hu Zhengfang1,Liu Kui2,Zhou Meng3,Jiang Xineng1,Feng Yaling1,Yu Zhicheng1,Li Yuhao3,Chen Songhua2,Wu Qian2,Wang Wei2,Horsburgh C Robert4,Zhang Yu2,Zhou Lin2,Chen Bin25,Hu Chonggao2,Martinez Leonardo4ORCID

Affiliation:

1. Department of Communicable Disease Control and Prevention, Lanxi Municipal Center for Disease Control and Prevention , Jinhua, Zhejiang Province , People's Republic of China

2. Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, Zhejiang Province , People's Republic of China

3. Department of Public Health, School of Medicine, Zhejiang University , Hangzhou, Zhejiang Province , People's Republic of China

4. Department of Epidemiology, School of Public Health , Boston University, Boston, MA , USA

5. Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province , Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province , People's Republic of China

Abstract

Abstract Background Mass tuberculosis (TB) screening has been recommended in certain high-risk populations. However, population-based screening interventions have rarely been implemented. Whether mass screening improves health equity is unknown. Methods We implemented a mass TB screening intervention among elderly persons (>60 years old) in Lanxi County, China. Standardized questionnaires, physical examinations, and chest radiographs (CXRs) were administered to all participants. Systematic testing with computed tomography, smear, culture, or Xpert was performed among persons with an abnormal CXR. We assessed TB prevalence per 100 000 persons and constructed multivariable regression models among subgroups that were and were not screened. Medical insurance was categorized as participation in either a basic program with limited coverage or a more comprehensive coverage program. Results In total, 49 339 individuals (32% of the elderly population in Lanxi) participated in the screening. One hundred fifteen screened persons were diagnosed with TB (233 cases per 100 000 persons), significantly higher than persons not screened (168 cases among 103 979 person-years; prevalence-to-case notification ratio, 1.44 [95% confidence interval {CI}, 1.14–1.83]). This increase was largely driven by diagnosis of asymptomatic disease during mass screening (n = 57 [50% of participants with TB]). Participants with basic medical insurance were much more likely to be diagnosed through mass screening than by passive detection (adjusted odds ratio, 4.52 [95% CI, 1.35–21.28]). Conclusions In a population-based, mass TB screening intervention encompassing >30% of the elderly population in a county in rural China, case finding was 44% higher than background detection, driven by diagnosis of TB without recognized symptoms. Importantly, mass screening identified TB in people with limited healthcare options who were less likely to be found through background case detection.

Funder

National-Zhejiang Health Commission Major S&T Project

Zhejiang Provincial Medical and Health Project

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

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