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背景:在全球范围内,结核病性别发病率的差异仍无根本性的解释。目的:探究旧金山市1991～1996年有可能解释结核病发病率性别差异的各种因素。设计:对旧金山市1991～1996年结核病特定性别发病率进行回顾性流行病学分析。按诊断时年龄、种族群、人类免疫缺陷病毒(HIV)感染情况以及出生地等进行分层分析。使用带有IS6110数据的分子指纹研究新感染和复燃结核病例发病率的性别差异。结果:研究期内,男性与女性发病率之比为2.1(95%CI 1.9～2.3)。分层分析显示年龄超过14岁可见性别发病率差异,美国出生人群、白种人和黑种人其男性:女性发病率之比最高。具有成簇指纹的病例比值也较高,这与美国出生人群近似。在以结核病复燃病例为主的人群,比值在青春期后高于一般情况,但这种影响报告的较少。结论:结核病在美国出生人口中不断的感染是可解释旧金山市性别发病率不同的原因之一。观察到的两性结核病发病率的差异,可能是由于传播动力学的不同,而不是来自诊断和报告的偏倚。
Background: The global differences in the incidence of tuberculosis are still not fundamentally explained. Aims: To explore various factors that may explain the gender differences in the incidence of tuberculosis in San Francisco from 1991 to 1996. DESIGN: A retrospective epidemiological analysis of TB-specific morbidity in San Francisco from 1991 to 1996. Stratified by age at diagnosis, ethnicity, HIV infection and birthplace. To use molecular fingerprinting with IS6110 data to study the gender differences in the incidence of new infections and relapse TB cases. Results: During the study period, the ratio of male to female morbidity was 2.1 (95% CI 1.9 to 2.3). Stratified analysis showed that gender differences in age over 14 years old were visible among male births, white births and blacks in the United States: the highest prevalence among women. There is also a higher ratio of cases with clustered fingerprints, similar to those born in the United States. In populations with a predominantly TB relapse, the ratio is higher than usual after puberty, but this effect is reported less. CONCLUSIONS: The persistent infection of tuberculosis in the U.S.-born population is one of the reasons explaining the different gender prevalence rates in San Francisco. The observed differences in the incidence of tuberculosis may be due to differences in transmission dynamics rather than bias from diagnosis and reporting.