Tuberculosis in Spain: epidemiological pattern and clinical practice
Abstract:SETTING: Thirteen Autonomous Regions in Spain.
OBJECTIVE: To study the incidence of all forms of tuberculosis (TB) and investigate clinical practice in TB.
DESIGN: Cases of all forms of tuberculosis diagnosed in the study setting from May 1986 to April 1997 were identified though active search of different databases. Clinical and epidemiological information on cases was collected from clinical records or by interview with physicians.
RESULTS: The overall incidence of all forms of tuberculosis was 38.5/100000 and the incidence of smear-positive disease was 13.83/100000. Most cases (97.1%) were Spanish nationals, with rates higher in men than in women (52.7/100000 vs. 24.87/100000) and in groups aged 25–34 and 75 years and over (61.35/100000 and 59.35/100000, respectively). Disseminated forms were frequent (6.6%), and the most common risk factor was human immunodeficiency virus (HIV) infection (17.7% of cases). Hospitalisation was common (71.6%). Microbiological confirmation of diagnosis was sought for 87.7% of the cases (91.8% of pulmonary vs. 75.5% of extra-pulmonary cases), and 65.2% were culture-positive (73.8% of pulmonary vs. 39.7% of extra-pulmonary cases). HIV-infected patients were treated in almost equal proportions with three or four drugs (49.7% and 48.2%, respectively), while HIV-negative cases or those whose HIV status was unknown were usually treated with three drugs.
CONCLUSION: The epidemiological pattern of TB in Spain is different to other industrialised countries in the age distribution of cases and the proportions of foreigners and cases with HIV infection. Microbiological confirmation of diagnosis is more common in pulmonary than in extra-pulmonary disease, and treatment with four drugs more frequent in HIV-positive cases.
Document Type: Regular Paper
Affiliations: 1: Unidad de Investigación en Tuberculosis, Instituto de Salud Carlos III, Madrid, Spain 2: Centro Español de Investigación Farmacoepidemiológica (CEIFE), Madrid, Spain 3: Unidad de Coordinación y Desarrollo de Investigación en Enfermería, Instituto de Salud Carlos III, Madrid, Spain 4: Merck Sharp and Dohme de España SA, Madrid, Spain 5: SIMAVE, SISTEMAS SL, Madrid, Spain 6: Hospital 12 de Octubre, Madrid, Spain 7: Dirección General de Salud Pública, Generalitat de Cataluña, Barcelona, Spain 8: Delegación Territorial de Sanidad, Gobierno Autónomo Vasco, Bilbao, Spain 9: Dirección General de Salud Pública, Junta de Extremadura, Badajoz, Spain 10: Complejo Hospitalario Cristal-Piñor, Orense, Spain 11: Servicio de Epidemiología, Consejería de Sanidad, Toledo, Spain 12: Dirección General de Salud, Gobierno Autónomo de La Rioja, Logroño, Spain 13: Hospital Universitario de Valme, Sevilla, Spain 14: Servicio de Epidemiología, Consejería de Sanidad y Consumo, Murcia, Spain 15: Dirección General de Salud Pública, Junta de Andalucía, Sevilla, Spain 16: Dirección General de Salud Pública, Principado de Asturias, Oviedo, Spain 17: Consejería de Sanidad, Consejo de Gobierno de la Ciudad Autónoma de Melilla, Melilla, Spain 18: Consejería de Sanidad, Consumo y Deportes, Consejo de Gobierno de la Ciudad Autónoma de Ceuta, Ceuta, Spain 19: Dirección General de Salud Pública, Generalitat Valenciana, Valencia, Spain 20: Dirección General de Salud Pública y Asistencia, Junta de Castilla y León, Valladolid, Spain
Publication date: April 1, 2002
The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.
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