背景:随着结核病(TB)发病率的迅速下降,韩国已经强调了潜伏性结核感染(LTBI)的重要性.尽管与其他国家相比,韩国的移民比例不高,越来越多的人认为,它应该积极接受移民,作为解决低出生率和人口老龄化问题的解决方案。这项研究旨在评估在韩国参加LTBI筛查试点计划的移民中的结核病发病率。
方法:2018年至2019年期间参加韩国LTBI筛查试点计划的移民记录与韩国国家结核病监测系统相关联,以确定结核病的发展。参与者接受了干扰素-γ释放试验(IGRA)和胸部X光检查。按年龄分层的标准化发病率(SIR),来源国的结核病负担是根据一般韩国人口的参考组计算的。
结果:共有9,517名参与者,确定了14例TB病例。IGRA阳性结果未开始LTBI治疗的参与者显示,结核病发病率为312.5/100,000人年,而那些阴性结果显示结核病发病率为每10万人年34.4,导致发病率比率为9.08(95%置信区间[CI],2.50-32.99)。总参与者(包括IGRA结果阴性的参与者)中TB的SIR为2.60(95%CI,1.54-4.38;P<0.001),而IGRA阳性的SIR为5.86(95%CI,3.15-10.89;P<0.001)。在计算IGRA结果为阳性的参与者之间的SIR时,来自高结核病负担国家或中等结核病负担国家的35岁以下人群表现出较高的SIR(18.08;95%CI,2.55-128.37;P=0.004),和11.30(95%CI,2.82-45.16;P<0.001),分别)。与以前的报告相反,这些报告表明,大多数IGRA阳性结果的老年人是由于远程感染,并且与年轻人相比,结核病风险较低。来自中等结核病负担国家的65岁或以上人群的SIR为6.15(95%CI,0.87-43.69;P=0.069),这与年龄在35至49岁之间的年轻参与者的情况相当(SIR,4.87;95%CI,1.22-19.49;P=0.025)或年龄在50至64岁之间的人(SIR,4.62;95%CI,1.73-12.31;P=0.002)。
结论:与普通韩国人群相比,来自高或中等结核病负担国家的IGRA阳性的年轻移民显示出相对较高的结核病风险。此外,在IGRA结果为阳性的老年移民中观察到意外的高TB风险.在为韩国移民制定未来的LTBI政策时,筛查应主要针对较年轻的年龄组(35岁以下)。此外,在老年移民中观察到的高结核病风险还需要进一步研究.
BACKGROUND: With a rapid decrease in tuberculosis (TB) incidence, the significance of latent tuberculosis infection (LTBI) has been underscored in South Korea. Although South Korea does not have a high proportion of immigrants compared to other countries, there is a growing argument that it should actively embrace immigrants as a solution to address issues of low birth rates and population aging. This study aimed to assess TB incidence among immigrants who participated a pilot LTBI screening program in South Korea.
METHODS: Records of immigrants participated in a pilot LTBI screening program in South Korea between 2018 and 2019 were linked with Korean National TB Surveillance System to determine TB development. Participants underwent interferon-gamma release assay (IGRA) and chest X-rays. Standardized incidence ratios (SIRs) stratified by age, country of origin\'s TB burden was calculated with a reference group of general South Korean population.
RESULTS: Of a total of 9,517 participants, 14 TB cases were identified. Participants with positive IGRA results who did not initiate LTBI treatment showed TB incidence of 312.5 per 100,000 person-years, whereas those with negative results showed TB incidence of 34.4 per 100,000 person-years, resulting in an incidence rate ratio of 9.08 (95% confidence interval [CI], 2.50-32.99). SIR of TB among total participants including those with negative IGRA results was 2.60 (95% CI, 1.54-4.38; P < 0.001), whereas SIR among those with positive IGRA results was 5.86 (95% CI, 3.15-10.89; P < 0.001). In the calculation of SIR among participants with positive IGRA results, those aged under 35 from high TB-burden countries or intermediate TB-burden countries showed a high SIR (18.08; 95% CI, 2.55-128.37; P = 0.004), and 11.30 (95% CI, 2.82-45.16; P < 0.001), respectively). Contrary to previous reports that suggest the majority of elderly population with a positive IGRA result were due to remote infection and had a lower TB risk compared to younger ages, SIR among those aged 65 or over from intermediate TB-burden countries was 6.15 (95% CI, 0.87-43.69; P = 0.069), which was comparable to that in younger participants aged between 35 and 49 (SIR, 4.87; 95% CI, 1.22-19.49; P = 0.025) or those aged between 50 and 64 (SIR, 4.62; 95% CI, 1.73-12.31; P = 0.002).
CONCLUSIONS: Young immigrants with positive IGRA results from countries with high or intermediate TB burden showed a relatively high TB risk compared to a general South Korea population. In addition, unexpected high TB risk was observed among elderly immigrants with positive IGRA results. In establishing future policies for LTBI in immigrants in South Korea, screenings should primarily focus on younger age group (who aged under 35). Additionally, further research is needed on the high TB risk observed in elderly immigrants.