Cargando…

Evaluation of underreporting tuberculosis in Central Italy by means of record linkage

BACKGROUND: Tuberculosis (TB) surveillance systems have some pitfalls outside of a National Tuberculosis Program and lack of efficient surveillance hampers accurate epidemiological quantification of TB burden. In the present study we assessed the quality of surveillance at the University Hospital in...

Descripción completa

Detalles Bibliográficos
Autores principales: Melosini, Lorenza, Vetrano, Umberto, Dente, Federico L, Cristofano, Michele, Giraldi, Mauro, Gabbrielli, Luciano, Novelli, Federica, Aquilini, Ferruccio, Rindi, Laura, Menichetti, Francesco, Freer, Giulia, Paggiaro, Pierluigi L
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3490729/
https://www.ncbi.nlm.nih.gov/pubmed/22897910
http://dx.doi.org/10.1186/1471-2458-12-472
_version_ 1782248859125153792
author Melosini, Lorenza
Vetrano, Umberto
Dente, Federico L
Cristofano, Michele
Giraldi, Mauro
Gabbrielli, Luciano
Novelli, Federica
Aquilini, Ferruccio
Rindi, Laura
Menichetti, Francesco
Freer, Giulia
Paggiaro, Pierluigi L
author_facet Melosini, Lorenza
Vetrano, Umberto
Dente, Federico L
Cristofano, Michele
Giraldi, Mauro
Gabbrielli, Luciano
Novelli, Federica
Aquilini, Ferruccio
Rindi, Laura
Menichetti, Francesco
Freer, Giulia
Paggiaro, Pierluigi L
author_sort Melosini, Lorenza
collection PubMed
description BACKGROUND: Tuberculosis (TB) surveillance systems have some pitfalls outside of a National Tuberculosis Program and lack of efficient surveillance hampers accurate epidemiological quantification of TB burden. In the present study we assessed the quality of surveillance at the University Hospital in Pisa (UHP), Italy, and TB incidence rates over a ten year period (1999–2008). METHODS: Assessment of underreporting was done by record-linkage from two sources: databases of TB diagnoses performed in the UHP and the Italian Infectious Disease Surveillance (IIDS) system. Two different databases were examined: a) TB diagnoses reported in the Hospital Discharge Records (HDR) from three Units of UHP (Respiratory Pathophysiology, Pulmonology and Infectious Diseases Units) (TB database A); b) TB diagnoses reported in HDR of all Units of UHP plus TB positive cases obtained by the Laboratory Register (LR) of UHP (TB database B). For the TB database A, the accuracy of TB diagnosis in HDR was assessed by direct examination of the Clinical Record Forms of the cases. For the TB database B, clinical and population data were described, as well as the trend of incidence and underreporting over 10 yrs. RESULTS: In the first study 293 patients were found: 80 patients (27%) with a confirmed TB diagnosis were underreported, 39 of them were microbiologically confirmed. Underreporting was related to age (Reported vs Non Reported, mean age: 49.27 ± 20 vs 55 ± 19, p < 0.005 ), diagnosis (smear positive vs negative cases 18.7 vs 81.2%, p = 0.001), microbiological confirmation (49% vs 51%, p < 0.05), X-ray findings (cavitary vs non-cavitary cases: 12.5 vs 87.5%, p = 0.001) but not to nationality. In the second study, 666 patients were found. Mean underreporting rate was 69.4% and decreased over time (68% in 1999, 48% in 2008). Newly diagnosed TB cases were also found to decrease in number whereas immigration rate increased. Underreporting was related to nationality (Immigrants vs Italians: 18% vs 68%, p < 0.001), diagnosis (microbiological confirmation: 25% vs 75%, p < 0.01), kind of hospital regimen (hospitalized patients vs Day Hospital: 70% vs 16%, p < 0.001), and position of TB code in the HDR (TB code in first position vs in the following position: 39,5% vs 45% p < 0.001). CONCLUSIONS: TB is underreported in Pisa, particularly in older patients and those without microbiological confirmation. The TB code in first position of HDR seems fairly accurate in confirming TB diagnosis.
format Online
Article
Text
id pubmed-3490729
institution National Center for Biotechnology Information
language English
publishDate 2012
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-34907292012-11-07 Evaluation of underreporting tuberculosis in Central Italy by means of record linkage Melosini, Lorenza Vetrano, Umberto Dente, Federico L Cristofano, Michele Giraldi, Mauro Gabbrielli, Luciano Novelli, Federica Aquilini, Ferruccio Rindi, Laura Menichetti, Francesco Freer, Giulia Paggiaro, Pierluigi L BMC Public Health Research Article BACKGROUND: Tuberculosis (TB) surveillance systems have some pitfalls outside of a National Tuberculosis Program and lack of efficient surveillance hampers accurate epidemiological quantification of TB burden. In the present study we assessed the quality of surveillance at the University Hospital in Pisa (UHP), Italy, and TB incidence rates over a ten year period (1999–2008). METHODS: Assessment of underreporting was done by record-linkage from two sources: databases of TB diagnoses performed in the UHP and the Italian Infectious Disease Surveillance (IIDS) system. Two different databases were examined: a) TB diagnoses reported in the Hospital Discharge Records (HDR) from three Units of UHP (Respiratory Pathophysiology, Pulmonology and Infectious Diseases Units) (TB database A); b) TB diagnoses reported in HDR of all Units of UHP plus TB positive cases obtained by the Laboratory Register (LR) of UHP (TB database B). For the TB database A, the accuracy of TB diagnosis in HDR was assessed by direct examination of the Clinical Record Forms of the cases. For the TB database B, clinical and population data were described, as well as the trend of incidence and underreporting over 10 yrs. RESULTS: In the first study 293 patients were found: 80 patients (27%) with a confirmed TB diagnosis were underreported, 39 of them were microbiologically confirmed. Underreporting was related to age (Reported vs Non Reported, mean age: 49.27 ± 20 vs 55 ± 19, p < 0.005 ), diagnosis (smear positive vs negative cases 18.7 vs 81.2%, p = 0.001), microbiological confirmation (49% vs 51%, p < 0.05), X-ray findings (cavitary vs non-cavitary cases: 12.5 vs 87.5%, p = 0.001) but not to nationality. In the second study, 666 patients were found. Mean underreporting rate was 69.4% and decreased over time (68% in 1999, 48% in 2008). Newly diagnosed TB cases were also found to decrease in number whereas immigration rate increased. Underreporting was related to nationality (Immigrants vs Italians: 18% vs 68%, p < 0.001), diagnosis (microbiological confirmation: 25% vs 75%, p < 0.01), kind of hospital regimen (hospitalized patients vs Day Hospital: 70% vs 16%, p < 0.001), and position of TB code in the HDR (TB code in first position vs in the following position: 39,5% vs 45% p < 0.001). CONCLUSIONS: TB is underreported in Pisa, particularly in older patients and those without microbiological confirmation. The TB code in first position of HDR seems fairly accurate in confirming TB diagnosis. BioMed Central 2012-06-21 /pmc/articles/PMC3490729/ /pubmed/22897910 http://dx.doi.org/10.1186/1471-2458-12-472 Text en Copyright ©2012 Melosini et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Melosini, Lorenza
Vetrano, Umberto
Dente, Federico L
Cristofano, Michele
Giraldi, Mauro
Gabbrielli, Luciano
Novelli, Federica
Aquilini, Ferruccio
Rindi, Laura
Menichetti, Francesco
Freer, Giulia
Paggiaro, Pierluigi L
Evaluation of underreporting tuberculosis in Central Italy by means of record linkage
title Evaluation of underreporting tuberculosis in Central Italy by means of record linkage
title_full Evaluation of underreporting tuberculosis in Central Italy by means of record linkage
title_fullStr Evaluation of underreporting tuberculosis in Central Italy by means of record linkage
title_full_unstemmed Evaluation of underreporting tuberculosis in Central Italy by means of record linkage
title_short Evaluation of underreporting tuberculosis in Central Italy by means of record linkage
title_sort evaluation of underreporting tuberculosis in central italy by means of record linkage
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3490729/
https://www.ncbi.nlm.nih.gov/pubmed/22897910
http://dx.doi.org/10.1186/1471-2458-12-472
work_keys_str_mv AT melosinilorenza evaluationofunderreportingtuberculosisincentralitalybymeansofrecordlinkage
AT vetranoumberto evaluationofunderreportingtuberculosisincentralitalybymeansofrecordlinkage
AT dentefedericol evaluationofunderreportingtuberculosisincentralitalybymeansofrecordlinkage
AT cristofanomichele evaluationofunderreportingtuberculosisincentralitalybymeansofrecordlinkage
AT giraldimauro evaluationofunderreportingtuberculosisincentralitalybymeansofrecordlinkage
AT gabbrielliluciano evaluationofunderreportingtuberculosisincentralitalybymeansofrecordlinkage
AT novellifederica evaluationofunderreportingtuberculosisincentralitalybymeansofrecordlinkage
AT aquiliniferruccio evaluationofunderreportingtuberculosisincentralitalybymeansofrecordlinkage
AT rindilaura evaluationofunderreportingtuberculosisincentralitalybymeansofrecordlinkage
AT menichettifrancesco evaluationofunderreportingtuberculosisincentralitalybymeansofrecordlinkage
AT freergiulia evaluationofunderreportingtuberculosisincentralitalybymeansofrecordlinkage
AT paggiaropierluigil evaluationofunderreportingtuberculosisincentralitalybymeansofrecordlinkage