Abstract：
BACKGROUND: Recently, extra-pulmonary tuberculosis (EPTB) has been increasingly reported in Bhutan, rising from 26% in 2001 to 39% in 2010. In 2016, almost half (49%) of all reported TB cases were classified as EPTB. Thus, this study was conducted to understand the epidemiology and identify risk factors contributing to increasing notification of EPTB in Bhutan.
METHODS: A case-control study was conducted by recruiting all 110 cases of nationally notified EPTB (Extrapulmonary bacteriologically confirmed/EPBC) as cases and 235 Pulmonary TB (Pulmonary bacteriologically confirmed/PBC) as controls. Data were collected on socio-demography, clinical and diagnostic, behavioral and lifestyle and environmental exposures using a structured questionnaire between April and September, 2018.
RESULTS: The median age of the cases was 25 years, ranged 9-79 years. Lymphatic TB was predominant (n = 78; 70.91%) followed by genitourinary TB (n = 4 (3.64%). The likelihood of EPTB decreased with increase in age (p = 0.023). The odds of EPTB in females was 1.65 times higher than the males (p = 0.038). Increase in Body Mass Index (adjusted odds ratio (AOR): 1.1; 95% confidence interval (CI): 1.052-1.200) and urban residency were (AOR 1.6; 95% CI 1.016-2.805) were found to have higher odds of developing EPTB.
CONCLUSIONS: Females, urban residents, and those with higher BMI are at increased risk of developing EPTB. These at-risk groups can be used to target limited public health resources to control EPTB in Bhutan.
METHODS: A case-control study was conducted by recruiting all 110 cases of nationally notified EPTB (Extrapulmonary bacteriologically confirmed/EPBC) as cases and 235 Pulmonary TB (Pulmonary bacteriologically confirmed/PBC) as controls. Data were collected on socio-demography, clinical and diagnostic, behavioral and lifestyle and environmental exposures using a structured questionnaire between April and September, 2018.
RESULTS: The median age of the cases was 25 years, ranged 9-79 years. Lymphatic TB was predominant (n = 78; 70.91%) followed by genitourinary TB (n = 4 (3.64%). The likelihood of EPTB decreased with increase in age (p = 0.023). The odds of EPTB in females was 1.65 times higher than the males (p = 0.038). Increase in Body Mass Index (adjusted odds ratio (AOR): 1.1; 95% confidence interval (CI): 1.052-1.200) and urban residency were (AOR 1.6; 95% CI 1.016-2.805) were found to have higher odds of developing EPTB.
CONCLUSIONS: Females, urban residents, and those with higher BMI are at increased risk of developing EPTB. These at-risk groups can be used to target limited public health resources to control EPTB in Bhutan.
摘要：
背景：最近，在不丹，肺外结核病（EPTB）的报道越来越多，从2001年的26%上升到2010年的39%。2016年，几乎一半（49％）的报告结核病病例被归类为EPTB。因此，进行这项研究是为了了解流行病学并确定导致不丹EPTB报告增加的危险因素。
方法：采用病例对照研究方法，招募全部110例国家通报的EPTB（肺外细菌学证实/EPBC）病例，235例肺结核病（肺内细菌学证实/PBC）病例作为对照。收集了社会人口数据，临床和诊断，在4月至9月之间使用结构化问卷进行行为和生活方式以及环境暴露，2018.
结果：病例的中位年龄为25岁，9-79岁。淋巴结核占主导地位（n=78；70.91%），其次是泌尿生殖系统结核（n=4（3.64%））。EPTB的可能性随着年龄的增加而降低(p=0.023)。女性发生EPTB的几率是男性的1.65倍(p=0.038)。发现身体质量指数（调整后比值比（AOR）：1.1；95％置信区间（CI）：1.052-1.200）和城市居住者（AOR1.6；95％CI1.016-2.805）具有较高的发生EPTB的几率。
结论：女性，城市居民,而那些BMI较高的人患EPTB的风险增加。这些高危人群可用于针对有限的公共卫生资源，以控制不丹的EPTB。
方法：采用病例对照研究方法，招募全部110例国家通报的EPTB（肺外细菌学证实/EPBC）病例，235例肺结核病（肺内细菌学证实/PBC）病例作为对照。收集了社会人口数据，临床和诊断，在4月至9月之间使用结构化问卷进行行为和生活方式以及环境暴露，2018.
结果：病例的中位年龄为25岁，9-79岁。淋巴结核占主导地位（n=78；70.91%），其次是泌尿生殖系统结核（n=4（3.64%））。EPTB的可能性随着年龄的增加而降低(p=0.023)。女性发生EPTB的几率是男性的1.65倍(p=0.038)。发现身体质量指数（调整后比值比（AOR）：1.1；95％置信区间（CI）：1.052-1.200）和城市居住者（AOR1.6；95％CI1.016-2.805）具有较高的发生EPTB的几率。
结论：女性，城市居民,而那些BMI较高的人患EPTB的风险增加。这些高危人群可用于针对有限的公共卫生资源，以控制不丹的EPTB。
