2013-08-012025-05-02https://scholars.lib.ntu.edu.tw/handle/123456789/728798背景:除了早期診斷及早期治療之外，現今公衛組織亦著眼於可能會增加結核病傳染或發病的社會相關 因素(social determinant factors)。在結核病相關的危險因子中，糖尿病引起特別的重視，除了因為 糖尿病及結核病之間的相關性，亦由於糖尿病在全球的高盛行率：糖尿病被發現可增加 2~4倍肺結核的 發病風險及 4倍左右結核病治癒後再復發的風險。全球糖尿病的人口正因人口老化、都市化等等因素而 增加，因此全球糖尿病的人口預期會由 2000年的 2.8%增加到 2030年的 4.4%，而這個現象可能在低收 入國家更加嚴重，如果不對糖尿病加以控制，可能使此些國家在結核病防治上的努力無法發揮成效。 目的與方法: 數理模式的優勢在可模擬不同風險趨勢下，不同的介入策施的影響下，而不需要在花費大 量的物資及人力的情形下進行研究。我們將使用數理模式來模擬糖尿病防治對全球 13個高結核病發生 個案國家的影響。針對每一個國家，我們將建立一個 S-L-I-R(susceptible-latent-infectious- recovered)結核病數理模型，並進一步分為有糖尿病或無糖尿病，建模過程及參數設定將參考過去主要 結核病數理模式相關研究。我們會將每一個國家的數理模式針對目前該國的糖尿病盛行率及結核病疫情 作校正，並用之來評估不同的糖尿病防治狀況下，對結核病的新增個案(incidence)及死亡率 (mortality) 的影響。 預期成果: 糖尿病在許多高結核病發生的國家都呈現不斷增加的趨勢，因之對於結核病疫情防治的影響 近年來受到國際高度重視，本研究結果將對高結核病疫情國家之結核病防治將有重大影響，同時亦可進 一步拿來評估其他危險因子(例如:吸菸，室內空氣汙染)對結核病疫情之影響。Background: Tuberculosis (TB) remains one of the biggest disease burden globally. In order to reach the goal of global TB elimination by 2050, preventive measures that address determinants of TB are likely to be needed in addition to curative interventions. Among the risk factors of TB, diabetes mellitus (DM) has aroused special attention because of the high prevalence of diabetes globally and the strong association between diabetes and TB. DM was noted to be associated with 2 -4 folds of increased risk of TB and 3.89 fold of risk of TB relapse. At the same, the population with DM is increasing due to aging, urbanization, Western diet, obesity, and physical inactivity; the global prevalence of DM is projected to increase from 2.8% in 2000 to 4.4% by 2030. With the increasing trend of DM globally, especially in the low income countries where TB burden is the highest, the current efforts on TB prevention and treatment may be dampened or even reserved. Objective: We aim to use a mathematical model to simulate the effect of DM control on the epidemic of TB in thirteen countries with high TB burden. Methods: We will construct a mathematic model to simulate the dynamic of TB transmission at the country- level and account for the interaction between DM and TB. A compartmental model that describes the natural history of TB (Susceptible-Latent-Infectious-Recovered, SLIR) will be construct for each country and calibrated to the observed diabetes and TB situation. After calibration we will project the impact of five different scenarios of DM control on future epidemiology of TB over the next 25 years. The impact will be evaluated by the number of incident TB cases and TB deaths averted over the study period comparing alternative DM scenarios to the status quo scenario. Anticipated results: Since DM is increasingly prevalent in many high TB burden countries, the results of our analysis will have important contribution to TB control policy in these countries. Furthermore, this modeling framework can be extended to other determinants of TB. Thus, the fundamental work can be used to test other novel strategies in TB prevention and control and to facilitate TB control globally.結核病糖尿病數理模型diabetestuberculosismathematical modeling