結核検診の現状と課題 DISCUSSING THE CURRENT SITUATION OF TUBERCULOSIS CASE-FINDING BY MASS MINIATURE RADIOGRAPHY IN JAPAN

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25歳以上の成人の60.3%, 人数にして5, 400万人が毎年定期の集団検診 (結核検診) を受診していると推計された。しかしながら定期集団検診による結核患者発見率は著しく低下し, 1998年には学校健診で受診者1, 000人対0.03, 職場健診で0.06, 住民健診で0.16までになった。ただし新登録中定期健診発見割合は過去10年ほぼ一定で, 1998年は12.8%であった。年齢別では20~30歳代で定期健診発見割合が大きく25.7%であり, 多くは職場健診からの発見であった。なお検診発見患者で排菌が確認されたのは35.1%であったが, この割合は高齢者でより大きかった。<BR>結核予防会で実施した40歳以上の住民健診成績から1名の結核患者の発見に要するコストは, 全体で440万円, 男で230万円, 女で840万円, 40歳代で730万円, 80歳以上では180万円と試算された。また罹患率人口10万対30の地域では400万円, 罹患率20では670万円と推計された。結核患者を2ヵ月入院, 4ヵ月外来で治療した場合, 治療費は約90万円と見積もられているので, 60歳未満の一般住民や罹患率50未満の地域では, 経費・効果の点で現行の結核検診は必ずしも効果的とは言いがたくなっている。しかしながら定期の結核検診のあり方については発見率やコストの他に発見患者の特性, 公共保健サービス, 国民の意思等も含めて検討する必要があるだろう。

The system of tuberculosis (TB) case-finding by mass miniature radiography (MMR) was established and expanded for almost all Japanese citizens in the 1950s. And, as stipulated by the TB Prevention Law, periodic mass screenings for schools, inhabitants, employees and institutions have been carried out. Among those aged over 25 years, the proportion of people screened by MMR was estimated to be 60.3%. This means that about 54 million people aged over 25 years are receiving medical service with MMR every year.<BR>Howerver, the detection rates of TB cases by MMR have declined markedly compared with those in 1950s. As of 1998, the detection rate was 0.03 per 1, 000 for school children and students, 0.06 per 1, 000 for employees, and 0.16 per 1, 000 for inhabitants.<BR>The proportion of cases detected by MMR among newly notified TB cases was 12.8% in 1998, and this ratio has been almost constant for the last 10 years. This ratio was greater among young adult TB cases. Approximately 20% of notified TB cases aged 20-39 years were detected by MMR for employees.<BR>Although the purpose of MMR is to find the cases before discharging TB bacilli, 35.1% of the cases were bacteriologically confirmed, and this proportion was greater among elderly TB cases.<BR>The Japan Anti-Tuberculosis Association (JATA) has been carrying out MMR for a long time. Eight selected branches of JATA that has been doing high quality case-finding reported 228 TB cases out of 965, 440 inhabitants aged over 40 years examined by MMR in 1996. Based on these results, the cost per TB case detected by MMR was calculated. The cost was 4.4 millions yen (\) per case for all forms of TB, \2.3 millions for male, \8.4 millions for female, \7.3 millions for those aged 40-49 years and Y 1.8 millions for those aged over 80 years.<BR>TB detection rate by MMR for inhabitants was correlated with TB incidence rate in various areas, and based on this correlation, the cost was calculated for various incidence rates. For all forms of TB, the cost was \4.0 millions per case for an incidence rate of 30 per 100, 000, and \6.7 millions for an incidence rate of 20 per 100, 000.<BR>MMR is not economically cost-effective even among elderly people and in areas with incidence rate less than 50 per 100, 000, because the medical expense for a TB patient treated under hospitalization for 2 months and outpatient's clinic for 4 months is approximately Y0.9 millions in 1996.<BR>The decision making in continuation or abolition or limitation of MMR should be discussed from a wide range of costeffectiveness analyses as well as from the view of public health service and willingness of people. For the purpose of decision making, this study provides the detection rates; the costs stratified by sex, age and incidence; and the proportion of cases detected by MMR among newly notified TB cases by age-group and bacteriological status.

収録刊行物

  • 結核

    結核 77(4), 329-339, 2002-04-15

    JAPANESE SOCIETY FOR TUBERCULOSIS

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各種コード

  • NII論文ID(NAID)
    10008579441
  • NII書誌ID(NCID)
    AN00073442
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    00229776
  • NDL 記事登録ID
    026779555
  • NDL 請求記号
    Z19-133
  • データ提供元
    CJP書誌  CJP引用  NDL  J-STAGE 
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