| Summary: | 碩士 === 國立臺灣大學 === 流行病學與預防醫學研究所 === 107 === Introduction
Tuberculosis (TB) is one of the leading infectious causes of mortality and morbidity in the world. Although the incidence rate has been decreasing slowly these years, there is still need efforts to prevent the disease. In Taiwan, the incidence of TB in the elderly is at least three times higher than in other age groups. To further understand the high incidence rate in the elderly, we conduct a risk factors analysis for the elderly population in Taiwan. We aim to indicate the real risk caused by well-known risk factors for TB among elders and identify novel elderly specific risk factors in Taiwan.
Methods
The study population was elderly participants from Taiwan’s 2001, 2005 and 2009 National Health Interview Survey (NHIS). Information for incident active TB cases was collected from the National TB registry dataset. Risk factors under consideration included demographic, health status, health behavior variables, and elderly specific variables. Incidence rates were calculated to show TB epidemic under exposure of different risk factors. Cox regression models were conducted to estimate hazard ratios for risk factors of TB and to find novel risk factors specific to the elderly. Population attributable fraction was calculated to show the impact of risk factors in Taiwan. All estimates accounted for study design were weighted.
Results
After average 5.85 years of follow-up, 67 TB cases occurred and 1,236 (26.5%) participants died among 4,657 participants. The incidence rate of TB during research period was 227 (95%CI: 179-288) per 100,000 person-year. Elderly with features of older age, male, low body mass index (BMI) or past history of lung disease had a significant association with active TB. If the distribution of lung disease was in a counterfactual situation, 16.4% of total cases could be prevented. Two novel risk factors show a positive result of increasing TB risk but without statistical significance.
Conclusion
Elderly population with past history of lung disease and low BMI status have significantly higher risk of active TB. Through findings in the study, the real effect of novel risk factors cannot be ascertained. The association between novel risk factors and active TB should be further explored through future research.
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