Results of Pulmonary Tuberculosis Screening for the Elderly Aged ≥ 65 years in Korea, 2019

Kim HeeAe; Shin JeeYeon; Kong Insik; On JinHee; Oh KeunYoung

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Epidemiology and Surveillance

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Public Health Weekly Report 2020; 13(13): 737-755

Published online March 26, 2020

Results of Pulmonary Tuberculosis Screening for the Elderly Aged ≥ 65 years in Korea, 2019

Kim HeeAe, Shin JeeYeon, Kong Insik, On JinHee, Oh KeunYoung

Division of TB & HIV/AIDS Control, Center for Disease Prevention, KCDC; Korean National Tuberculosis Association

^*교신저자 : insik.kong@korea.kr, 043-719-7310

This is an Open Access aritcle distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted distribution, and reproduction in any medium, provided the original work is properly cited.

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The Korea Centers for Disease Control and Prevention (KCDC) conducted an early stage tuberculosis (TB) screening pilot project for the elderly in 2019. The aim was to detect TB in seniors over the age of 65 living in regions with high TB incidences and high TB-related deaths, and to prevent transmission.
In 2019, the pilot project conducted test in six regions of Korea: Chungcheongnam-do (Asan, Taean), Jeollanam-do (Suncheon, Hampyeong), and Gyeongsangbuk-do (Gyeongju, Pohang). Among the 58,500 screening targets, 46,247 (79.1%) participated in the project. Chest x-ray and sputum tests were performed and 62 TB patients (134 per 100,000) were reported. Nationwide, this data represented 92.4% of the incidence of TB (145 people per 100,000 people) aged 65 years or older male, elderly, under weight, medical benefit recipient, living alone, smoker, suspected TB, history of history of TB contact. The Pilot confirmed that the incidence of TB was high in the case of underlying disease. In addition, although 51.6% (32/62) of TB confirmed patients were identified as having inactive TB chest X-ray examination.
Furthermore, as a result of analyzing the treatment success rate of TB patients (74) in a 2018 pilot project for TB screening for the elderly, it was found that the treatment success rate was higher than that of the general population. This confirmed that early detection and follow-up of TB patients increased the success rate of treatment for TB.
The KCDC intends to implement a nationwide geriatric TB screening project in 2020 based on the screening protocol established through the 2018 TB screening pilot project. In terms of the targets of the 2020 project, priority will be given to the elderly with medical care and the elderly who are at home and who have less chance of TB screening and have a higher incidence of TB. Through this, vulnerable populations who are in the blind spot for TB screening will be managed, and early detection and treatment of TB patients will prevent transmission and improve public health.

Key words Tuberculosis (TB), Tuberculosis in the elderly, Chest X-ray examination, Sputum examination, Incidence

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Table 1. Characteristics of tuberculosis screening participants and TB patients

Variables	Participants						TB patients			p-value
	Total		Community		Long-term care facility		TB patients
	n	%	n	%	n	%	n	%	Incidence rate (per 100,000 people)
Total	46,247	100.0	35,831	77.5	10,416	22.5	62	100.0	134
Sex										0.001
Male	14,961	32.4	12,763	35.6	2,198	21.1	32	51.6	214
Female	31,286	67.6	23,068	64.4	8,218	78.9	30	48.4	96
Age										0.036
≤ 64	1,988	4.3	903	2.5	1,085	10.4	1	1.6	50
65-69	6,300	13.6	5,920	16.5	380	3.6	3	4.8	48
70-74	8,528	18.4	7,954	22.2	574	5.5	8	12.9	94
75-79	11,378	24.6	10,077	28.1	1,301	12.5	18	29.0	158
≥ 80	18,053	39.0	10,977	30.6	7,076	67.9	32	51.6	177
BMI (Kg/m²)										0.004
Under weight(<18.5)	2,977	6.4	1,229	3.4	1,748	16.8	7	11.3	235
Normal weight(18.5-22.9)	25,033	54.1	19,342	54.0	5,691	54.6	41	66.1	164
Over weight(23.0-24.9)	8,942	19.3	7,496	20.9	1,446	13.9	8	12.9	89
Obese(≥25.0)	8,986	19.4	7,508	21.0	1,478	14.2	6	9.7	67
Unknown	309	0.7	256	0.7	53	0.5	-	-	-
Area										0.191
Chungcheongnam-do	15,345	33.2	11,744	32.8	3,601	34.6	17	27.4	111
Jeollanam-do	15,084	32.6	8,603	24.0	6,481	62.2	17	27.4	113
Gyeongsangbuk-do	15,818	34.2	15,484	43.2	334	3.2	28	45.2	177
Health insurance										0.020
National health insurance (work, district)	40,423	87.4	32,365	90.3	8,058	77.3	52	83.9	128
Medical care (type1, 2)	3,558	7.7	1,613	4.5	1,945	18.7	10	16.1	281
Unknown	2,266	4.9	1,853	5.2	413	4.0	-	-	-
Living alone										0.339
Yes	10,570	22.9	10,570	29.5	-	-	18	29.0	171
No	25,259	54.6	25,259	70.5	-	-	34	54.8	135
Long-term-care facility	10,416	22.5	-	-	10,416	100.0	10	16.1	96
Unknown	2	0.0	2	0.0	-	-	-	-	-
Smoking (include ex-smoker)										0.026
Yes	9,593	20.7	8,611	24.0	982	9.4	21	33.9	219
No	33,295	72.0	27,162	75.8	6,133	58.9	39	62.9	117
Unknown	3,359	7.3	58	0.2	3,301	31.7	2	3.2	60
Underlying disease										0.977
Yes	29,009	62.7	23,409	65.3	5,600	53.8	39	62.9	134
No	17,238	37.3	12,422	34.7	4,816	46.2	23	37.1	133
Active daily living										0.168
Normal	40,845	87.5	35,823	100.0	5,022	48.2	59	95.2	146
Physically disabled	3,376	7.3	5	0.0	3,371	32.4	3	4.8	89
Bed-ridden	2,026	4.3	3	0.0	2,023	19.4	-	-	-
TB symptoms (Cough over 2 weeks and other symptoms)										0.003
Yes	4,483	9.7	4,146	11.6	337	3.2	13	21.0	290
No	41,764	90.3	31,685	88.4	10,079	96.8	49	79.0	117
TB History										<0.000
Yes	1,822	3.9	1,601	4.5	221	2.1	14	22.6	768
No	41,126	88.9	33,827	94.4	7,299	70.1	45	72.6	109
Unknown	3,299	7.1	403	1.1	2,896	27.8	3	4.8	91
Contact of TB patients										0.242
Yes	1,253	2.7	1,199	3.3	54	0.5	3	4.8	239
No	38,242	82.7	34,050	95.0	4,192	40.2	55	88.7	144
Unknown	6,752	14.6	582	1.6	6,170	59.2	4	6.5	59

Table 2. Clinical characteristics of tuberculosis (TB) patients diagnosed in the screening, 2019

	Participants		TB patients
	n	%	n	%
Total	46,247	100.0	62	100.0
Chest x-ray
Subtotal	46,246	100.0	62	100.0
Normal	34,292	74.1	-	-
Need treatment^*	77	0.2	7	11.3
Observation require^†	529	1.1	20	32.3
Inactive TB^‡	4,057	8.8	32	51.6
Other diseases suspected	7,291	15.8	3	4.8
Sputum smear
Subtotal	8,357	100.0	62	100.0
Positive	51	0.6	19	30.7
Negative	8,306	99.4	43	69.3
Sputum culture
Subtotal	8,357	100.0	62	100.0
Positive	55	0.7	55	88.7
Negative	8,117	97.1	7	11.3
NTM^§	185	2.2	-	-
TB-PCR test^∥
Subtotal	8,357	100.0	62	100.0
Positive	32	0.4	31	50.0
Negative	8,255	98.8	25	40.3
NTM^§	58	0.7	-	-
Contamination	2	-	-	-
Not done	10	0.1	6	9.7
Drug sensitivity test
Subtotal	-	-	20	32.3
Rifampin(R) Drug sensitivity	-	-	19	30.6
Rifampin(R) Drug resistance	-	-	1	1.6

* ‘Active pulmonary tuberculosis’ or ‘exudation pleural effusion’ which is presumed to be tuberculous, suggesting the treatment of tuberculosis, sputum examination for confirmation

^† Any suspicion of ‘active tuberculosis’ or ‘suspected tuberculosis’, the final diagnosis of the doctor is necessary, including the additional tuberculosis test including sputum examination and the clinical findings of the patient in public health centers and medical institutions

^‡ Pulmonary tuberculosis developed in the past but remained healed and traces of fibrotic changes remain

^§ Means anti-bacterial bacteria except tuberculosis and leprosy, and diseases caused by non-tuberculosis antibacterial bacteria are classified as characteristic clinical syndromes such as lung disease, lymphadenitis, skin, soft tissue, bone infection, and disseminated disease.

^∥ M. tuberculosis-polymerase chain reaction (TB-PCR)

Table 3. Clinical characteristics of Inactive tuberculosis (TB) patients diagnosed in the screening, 2019

Characteristics	Inactive TB patients
Characteristics	n	%
Total	32	100.0
Sex
Male	19	59.4
Female	13	40.6
Age
≤ 64	-	-
65-69	-	-
70-74	7	21.9
75-79	12	37.5
≥ 80	13	40.6
BMI (Kg/m²)
Under weight (<18.5)	4	12.5
Normal weight (18.5-22.9)	18	56.3
Over weight (23.0-24.9)	7	21.9
Obese (≥25.0)	3	9.4
Health Insurance
National health insurance (work, district)	29	90.6
Medical care (type1, 2)	3	9.4
Living alone
Yes	9	28.1
No	18	56.2
Long-term-care facility	5	15.6
Smoking (include ex-smoker)
Yes	14	43.8
No	18	56.2
Active daily living
Normal	30	93.8
Physically disabled	2	6.3
Bed-ridden	-	-
TB symptoms (Cough over 2 weeks and other symptoms)
Yes	7	21.9
No	25	78.1
TB history
Yes	10	31.3
No	22	68.8
Contact of TB patients
Yes	1	3.1
No	30	93.8
Unknown	1	3.1
Underlying disease
Yes	16	50.0
No	16	50.0
Sputum smear
Positive	4	12.5
Negative	28	87.5
Sputum culture
Positive	27	84.4
Negative	5	15.6
TB-PCR test
Positive	14	43.8
Negative	17	53.1
Not done	1	3.1
Drug sensitivity test
Rifampin (R) Drug sensitivity	4	12.5
Rifampin (R) Drug resistance	-	-

Table 4. Comparison of tuberculosis (TB) incidence rates between pilot project group and general population

Characteristics	Pilot project group			General population 2018
Characteristics	No. of participants	TB patients	Incidence rate (per 100,000 people)	No. of elderly	TB patients	Incidence rate (per 100,000 people)
Total	46,247^*	62	134	923,007^†	1,214	132
Chungcheongnam-do	15,345^*	17	111	376,206^†	409	109
Community	11,537	16	139	56,870	67	118
Asan	8,034	9	112	38,696	38	98
Taean	3,503	7	200	18,174	29	160
Long-term care facility	3,601	1	28	376,206	409	109
Other^‡	207	0	0	62,582	61	97
Jeollanam-do	15,084^*	17	113	414,749^†	609	147
Community	7,314	8	109	52,561	56	107
Suncheon	5,474	5	91	41,162	28	68
Hampyung	1,840	3	163	11,399	28	246
Long-term care facility	6,481	9	139	414,749	609	147
Other^‡	1,289	0	0	225,943	328	145
Gyeongsangbuk-do	15,818^*	28	177	132,052^†	196	148
Community	15,484	28	181	132,052	196	148
Gyeongju	7,143	14	196	53,147	79	149
Pohang	8,341	14	168	78,905	117	148
Long-term care facility	334	0	0	132,052	196	148

* Tuberculosis screening participants, 2019

^† Number of elderly people aged 65 and over in the area of tuberculosis screening in 2019

^‡ Tuberculosis screening is conducted for senior citizens of the community who wish to participate in tuberculosis screening projects in Chungcheongnam-do (3 area), Jeollanam-do (11 area).

Table 5. Comparison of tuberculosis (TB) patients treatment rates between pilot project group and general population

Characteristics	Pilot project group		General population aged 65 years and over, 2018
Characteristics	n	%	n	%
No. of participants	74	100.0	12,652	100.0
Cured / Completed	61	82.4	9,645	76.2
Defaulted / Failed	3	4.1	131	1.0
Died	9	12.2	2,821	22.3
Under treatment	1	1.4	55	0.4

*Source: Integrated Disease and Health Control System – TB Control : http://is.cdc.go.kr

Figure 1. New tuberculosis (TB) notification rates by age, 2010-2019
*Source: Annual Report on the Notified Tuberculosis in Korea, 2019. KCDC

Figure 2. Tuberculosis (TB) screening procedure
*Excluding 548 people who are TB symptoms and Abnormal

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Epidemiology and Surveillance

Public Health Weekly Report 2020; 13(13): 737-755

Published online March 26, 2020

Results of Pulmonary Tuberculosis Screening for the Elderly Aged ≥ 65 years in Korea, 2019

Kim HeeAe, Shin JeeYeon, Kong Insik, On JinHee, Oh KeunYoung

Division of TB & HIV/AIDS Control, Center for Disease Prevention, KCDC; Korean National Tuberculosis Association

Correspondence to:^*교신저자 : insik.kong@korea.kr, 043-719-7310

Abstract

Keywords: Tuberculosis (TB), Tuberculosis in the elderly, Chest X-ray examination, Sputum examination, Incidence

Body

Table 1 Characteristics of tuberculosis screening participants and TB patients

Variables	Participants						TB patients			p-value
	Total		Community		Long-term care facility		TB patients
	n	%	n	%	n	%	n	%	Incidence rate (per 100,000 people)
Total	46,247	100.0	35,831	77.5	10,416	22.5	62	100.0	134
Sex										0.001
Male	14,961	32.4	12,763	35.6	2,198	21.1	32	51.6	214
Female	31,286	67.6	23,068	64.4	8,218	78.9	30	48.4	96
Age										0.036
≤ 64	1,988	4.3	903	2.5	1,085	10.4	1	1.6	50
65-69	6,300	13.6	5,920	16.5	380	3.6	3	4.8	48
70-74	8,528	18.4	7,954	22.2	574	5.5	8	12.9	94
75-79	11,378	24.6	10,077	28.1	1,301	12.5	18	29.0	158
≥ 80	18,053	39.0	10,977	30.6	7,076	67.9	32	51.6	177
BMI (Kg/m²)										0.004
Under weight(<18.5)	2,977	6.4	1,229	3.4	1,748	16.8	7	11.3	235
Normal weight(18.5-22.9)	25,033	54.1	19,342	54.0	5,691	54.6	41	66.1	164
Over weight(23.0-24.9)	8,942	19.3	7,496	20.9	1,446	13.9	8	12.9	89
Obese(≥25.0)	8,986	19.4	7,508	21.0	1,478	14.2	6	9.7	67
Unknown	309	0.7	256	0.7	53	0.5	-	-	-
Area										0.191
Chungcheongnam-do	15,345	33.2	11,744	32.8	3,601	34.6	17	27.4	111
Jeollanam-do	15,084	32.6	8,603	24.0	6,481	62.2	17	27.4	113
Gyeongsangbuk-do	15,818	34.2	15,484	43.2	334	3.2	28	45.2	177
Health insurance										0.020
National health insurance (work, district)	40,423	87.4	32,365	90.3	8,058	77.3	52	83.9	128
Medical care (type1, 2)	3,558	7.7	1,613	4.5	1,945	18.7	10	16.1	281
Unknown	2,266	4.9	1,853	5.2	413	4.0	-	-	-
Living alone										0.339
Yes	10,570	22.9	10,570	29.5	-	-	18	29.0	171
No	25,259	54.6	25,259	70.5	-	-	34	54.8	135
Long-term-care facility	10,416	22.5	-	-	10,416	100.0	10	16.1	96
Unknown	2	0.0	2	0.0	-	-	-	-	-
Smoking (include ex-smoker)										0.026
Yes	9,593	20.7	8,611	24.0	982	9.4	21	33.9	219
No	33,295	72.0	27,162	75.8	6,133	58.9	39	62.9	117
Unknown	3,359	7.3	58	0.2	3,301	31.7	2	3.2	60
Underlying disease										0.977
Yes	29,009	62.7	23,409	65.3	5,600	53.8	39	62.9	134
No	17,238	37.3	12,422	34.7	4,816	46.2	23	37.1	133
Active daily living										0.168
Normal	40,845	87.5	35,823	100.0	5,022	48.2	59	95.2	146
Physically disabled	3,376	7.3	5	0.0	3,371	32.4	3	4.8	89
Bed-ridden	2,026	4.3	3	0.0	2,023	19.4	-	-	-
TB symptoms (Cough over 2 weeks and other symptoms)										0.003
Yes	4,483	9.7	4,146	11.6	337	3.2	13	21.0	290
No	41,764	90.3	31,685	88.4	10,079	96.8	49	79.0	117
TB History										<0.000
Yes	1,822	3.9	1,601	4.5	221	2.1	14	22.6	768
No	41,126	88.9	33,827	94.4	7,299	70.1	45	72.6	109
Unknown	3,299	7.1	403	1.1	2,896	27.8	3	4.8	91
Contact of TB patients										0.242
Yes	1,253	2.7	1,199	3.3	54	0.5	3	4.8	239
No	38,242	82.7	34,050	95.0	4,192	40.2	55	88.7	144
Unknown	6,752	14.6	582	1.6	6,170	59.2	4	6.5	59

Table 2 Clinical characteristics of tuberculosis (TB) patients diagnosed in the screening, 2019

	Participants		TB patients
	n	%	n	%
Total	46,247	100.0	62	100.0
Chest x-ray
Subtotal	46,246	100.0	62	100.0
Normal	34,292	74.1	-	-
Need treatment^*	77	0.2	7	11.3
Observation require^†	529	1.1	20	32.3
Inactive TB^‡	4,057	8.8	32	51.6
Other diseases suspected	7,291	15.8	3	4.8
Sputum smear
Subtotal	8,357	100.0	62	100.0
Positive	51	0.6	19	30.7
Negative	8,306	99.4	43	69.3
Sputum culture
Subtotal	8,357	100.0	62	100.0
Positive	55	0.7	55	88.7
Negative	8,117	97.1	7	11.3
NTM^§	185	2.2	-	-
TB-PCR test^∥
Subtotal	8,357	100.0	62	100.0
Positive	32	0.4	31	50.0
Negative	8,255	98.8	25	40.3
NTM^§	58	0.7	-	-
Contamination	2	-	-	-
Not done	10	0.1	6	9.7
Drug sensitivity test
Subtotal	-	-	20	32.3
Rifampin(R) Drug sensitivity	-	-	19	30.6
Rifampin(R) Drug resistance	-	-	1	1.6

* ‘Active pulmonary tuberculosis’ or ‘exudation pleural effusion’ which is presumed to be tuberculous, suggesting the treatment of tuberculosis, sputum examination for confirmation.

^‡ Pulmonary tuberculosis developed in the past but remained healed and traces of fibrotic changes remain.

^∥ M. tuberculosis-polymerase chain reaction (TB-PCR).

Table 3 Clinical characteristics of Inactive tuberculosis (TB) patients diagnosed in the screening, 2019

Characteristics	Inactive TB patients
Characteristics	n	%
Total	32	100.0
Sex
Male	19	59.4
Female	13	40.6
Age
≤ 64	-	-
65-69	-	-
70-74	7	21.9
75-79	12	37.5
≥ 80	13	40.6
BMI (Kg/m²)
Under weight (<18.5)	4	12.5
Normal weight (18.5-22.9)	18	56.3
Over weight (23.0-24.9)	7	21.9
Obese (≥25.0)	3	9.4
Health Insurance
National health insurance (work, district)	29	90.6
Medical care (type1, 2)	3	9.4
Living alone
Yes	9	28.1
No	18	56.2
Long-term-care facility	5	15.6
Smoking (include ex-smoker)
Yes	14	43.8
No	18	56.2
Active daily living
Normal	30	93.8
Physically disabled	2	6.3
Bed-ridden	-	-
TB symptoms (Cough over 2 weeks and other symptoms)
Yes	7	21.9
No	25	78.1
TB history
Yes	10	31.3
No	22	68.8
Contact of TB patients
Yes	1	3.1
No	30	93.8
Unknown	1	3.1
Underlying disease
Yes	16	50.0
No	16	50.0
Sputum smear
Positive	4	12.5
Negative	28	87.5
Sputum culture
Positive	27	84.4
Negative	5	15.6
TB-PCR test
Positive	14	43.8
Negative	17	53.1
Not done	1	3.1
Drug sensitivity test
Rifampin (R) Drug sensitivity	4	12.5
Rifampin (R) Drug resistance	-	-

Table 4 Comparison of tuberculosis (TB) incidence rates between pilot project group and general population

Characteristics	Pilot project group			General population 2018
Characteristics	No. of participants	TB patients	Incidence rate (per 100,000 people)	No. of elderly	TB patients	Incidence rate (per 100,000 people)
Total	46,247^*	62	134	923,007^†	1,214	132
Chungcheongnam-do	15,345^*	17	111	376,206^†	409	109
Community	11,537	16	139	56,870	67	118
Asan	8,034	9	112	38,696	38	98
Taean	3,503	7	200	18,174	29	160
Long-term care facility	3,601	1	28	376,206	409	109
Other^‡	207	0	0	62,582	61	97
Jeollanam-do	15,084^*	17	113	414,749^†	609	147
Community	7,314	8	109	52,561	56	107
Suncheon	5,474	5	91	41,162	28	68
Hampyung	1,840	3	163	11,399	28	246
Long-term care facility	6,481	9	139	414,749	609	147
Other^‡	1,289	0	0	225,943	328	145
Gyeongsangbuk-do	15,818^*	28	177	132,052^†	196	148
Community	15,484	28	181	132,052	196	148
Gyeongju	7,143	14	196	53,147	79	149
Pohang	8,341	14	168	78,905	117	148
Long-term care facility	334	0	0	132,052	196	148

* Tuberculosis screening participants, 2019.

^† Number of elderly people aged 65 and over in the area of tuberculosis screening in 2019.

^‡ Tuberculosis screening is conducted for senior citizens of the community who wish to participate in tuberculosis screening projects in Chungcheongnam-do (3 area), Jeollanam-do (11 area)..

Table 5 Comparison of tuberculosis (TB) patients treatment rates between pilot project group and general population

Characteristics	Pilot project group		General population aged 65 years and over, 2018
Characteristics	n	%	n	%
No. of participants	74	100.0	12,652	100.0
Cured / Completed	61	82.4	9,645	76.2
Defaulted / Failed	3	4.1	131	1.0
Died	9	12.2	2,821	22.3
Under treatment	1	1.4	55	0.4

*Source: Integrated Disease and Health Control System – TB Control : http://is.cdc.go.kr.

Figure 1. New tuberculosis (TB) notification rates by age, 2010-2019
*Source: Annual Report on the Notified Tuberculosis in Korea, 2019. KCDC

Figure 2. Tuberculosis (TB) screening procedure
*Excluding 548 people who are TB symptoms and Abnormal

Abstract
Body

Fig 1.

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Figure 1.New tuberculosis (TB) notification rates by age, 2010-2019
*Source: Annual Report on the Notified Tuberculosis in Korea, 2019. KCDC

Public Health Weekly Report 2020; 13: 737-755

Fig 2.

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Figure 2.Tuberculosis (TB) screening procedure
*Excluding 548 people who are TB symptoms and Abnormal

Public Health Weekly Report 2020; 13: 737-755

Table 1 Characteristics of tuberculosis screening participants and TB patients

Variables	Participants						TB patients			p-value
	Total		Community		Long-term care facility		TB patients
	n	%	n	%	n	%	n	%	Incidence rate (per 100,000 people)
Total	46,247	100.0	35,831	77.5	10,416	22.5	62	100.0	134
Sex										0.001
Male	14,961	32.4	12,763	35.6	2,198	21.1	32	51.6	214
Female	31,286	67.6	23,068	64.4	8,218	78.9	30	48.4	96
Age										0.036
≤ 64	1,988	4.3	903	2.5	1,085	10.4	1	1.6	50
65-69	6,300	13.6	5,920	16.5	380	3.6	3	4.8	48
70-74	8,528	18.4	7,954	22.2	574	5.5	8	12.9	94
75-79	11,378	24.6	10,077	28.1	1,301	12.5	18	29.0	158
≥ 80	18,053	39.0	10,977	30.6	7,076	67.9	32	51.6	177
BMI (Kg/m²)										0.004
Under weight(<18.5)	2,977	6.4	1,229	3.4	1,748	16.8	7	11.3	235
Normal weight(18.5-22.9)	25,033	54.1	19,342	54.0	5,691	54.6	41	66.1	164
Over weight(23.0-24.9)	8,942	19.3	7,496	20.9	1,446	13.9	8	12.9	89
Obese(≥25.0)	8,986	19.4	7,508	21.0	1,478	14.2	6	9.7	67
Unknown	309	0.7	256	0.7	53	0.5	-	-	-
Area										0.191
Chungcheongnam-do	15,345	33.2	11,744	32.8	3,601	34.6	17	27.4	111
Jeollanam-do	15,084	32.6	8,603	24.0	6,481	62.2	17	27.4	113
Gyeongsangbuk-do	15,818	34.2	15,484	43.2	334	3.2	28	45.2	177
Health insurance										0.020
National health insurance (work, district)	40,423	87.4	32,365	90.3	8,058	77.3	52	83.9	128
Medical care (type1, 2)	3,558	7.7	1,613	4.5	1,945	18.7	10	16.1	281
Unknown	2,266	4.9	1,853	5.2	413	4.0	-	-	-
Living alone										0.339
Yes	10,570	22.9	10,570	29.5	-	-	18	29.0	171
No	25,259	54.6	25,259	70.5	-	-	34	54.8	135
Long-term-care facility	10,416	22.5	-	-	10,416	100.0	10	16.1	96
Unknown	2	0.0	2	0.0	-	-	-	-	-
Smoking (include ex-smoker)										0.026
Yes	9,593	20.7	8,611	24.0	982	9.4	21	33.9	219
No	33,295	72.0	27,162	75.8	6,133	58.9	39	62.9	117
Unknown	3,359	7.3	58	0.2	3,301	31.7	2	3.2	60
Underlying disease										0.977
Yes	29,009	62.7	23,409	65.3	5,600	53.8	39	62.9	134
No	17,238	37.3	12,422	34.7	4,816	46.2	23	37.1	133
Active daily living										0.168
Normal	40,845	87.5	35,823	100.0	5,022	48.2	59	95.2	146
Physically disabled	3,376	7.3	5	0.0	3,371	32.4	3	4.8	89
Bed-ridden	2,026	4.3	3	0.0	2,023	19.4	-	-	-
TB symptoms (Cough over 2 weeks and other symptoms)										0.003
Yes	4,483	9.7	4,146	11.6	337	3.2	13	21.0	290
No	41,764	90.3	31,685	88.4	10,079	96.8	49	79.0	117
TB History										<0.000
Yes	1,822	3.9	1,601	4.5	221	2.1	14	22.6	768
No	41,126	88.9	33,827	94.4	7,299	70.1	45	72.6	109
Unknown	3,299	7.1	403	1.1	2,896	27.8	3	4.8	91
Contact of TB patients										0.242
Yes	1,253	2.7	1,199	3.3	54	0.5	3	4.8	239
No	38,242	82.7	34,050	95.0	4,192	40.2	55	88.7	144
Unknown	6,752	14.6	582	1.6	6,170	59.2	4	6.5	59

Table 2 Clinical characteristics of tuberculosis (TB) patients diagnosed in the screening, 2019

	Participants		TB patients
	n	%	n	%
Total	46,247	100.0	62	100.0
Chest x-ray
Subtotal	46,246	100.0	62	100.0
Normal	34,292	74.1	-	-
Need treatment^*	77	0.2	7	11.3
Observation require^†	529	1.1	20	32.3
Inactive TB^‡	4,057	8.8	32	51.6
Other diseases suspected	7,291	15.8	3	4.8
Sputum smear
Subtotal	8,357	100.0	62	100.0
Positive	51	0.6	19	30.7
Negative	8,306	99.4	43	69.3
Sputum culture
Subtotal	8,357	100.0	62	100.0
Positive	55	0.7	55	88.7
Negative	8,117	97.1	7	11.3
NTM^§	185	2.2	-	-
TB-PCR test^∥
Subtotal	8,357	100.0	62	100.0
Positive	32	0.4	31	50.0
Negative	8,255	98.8	25	40.3
NTM^§	58	0.7	-	-
Contamination	2	-	-	-
Not done	10	0.1	6	9.7
Drug sensitivity test
Subtotal	-	-	20	32.3
Rifampin(R) Drug sensitivity	-	-	19	30.6
Rifampin(R) Drug resistance	-	-	1	1.6

* ‘Active pulmonary tuberculosis’ or ‘exudation pleural effusion’ which is presumed to be tuberculous, suggesting the treatment of tuberculosis, sputum examination for confirmation.

^‡ Pulmonary tuberculosis developed in the past but remained healed and traces of fibrotic changes remain.

^∥ M. tuberculosis-polymerase chain reaction (TB-PCR).

Table 3 Clinical characteristics of Inactive tuberculosis (TB) patients diagnosed in the screening, 2019

Characteristics	Inactive TB patients
Characteristics	n	%
Total	32	100.0
Sex
Male	19	59.4
Female	13	40.6
Age
≤ 64	-	-
65-69	-	-
70-74	7	21.9
75-79	12	37.5
≥ 80	13	40.6
BMI (Kg/m²)
Under weight (<18.5)	4	12.5
Normal weight (18.5-22.9)	18	56.3
Over weight (23.0-24.9)	7	21.9
Obese (≥25.0)	3	9.4
Health Insurance
National health insurance (work, district)	29	90.6
Medical care (type1, 2)	3	9.4
Living alone
Yes	9	28.1
No	18	56.2
Long-term-care facility	5	15.6
Smoking (include ex-smoker)
Yes	14	43.8
No	18	56.2
Active daily living
Normal	30	93.8
Physically disabled	2	6.3
Bed-ridden	-	-
TB symptoms (Cough over 2 weeks and other symptoms)
Yes	7	21.9
No	25	78.1
TB history
Yes	10	31.3
No	22	68.8
Contact of TB patients
Yes	1	3.1
No	30	93.8
Unknown	1	3.1
Underlying disease
Yes	16	50.0
No	16	50.0
Sputum smear
Positive	4	12.5
Negative	28	87.5
Sputum culture
Positive	27	84.4
Negative	5	15.6
TB-PCR test
Positive	14	43.8
Negative	17	53.1
Not done	1	3.1
Drug sensitivity test
Rifampin (R) Drug sensitivity	4	12.5
Rifampin (R) Drug resistance	-	-

Table 4 Comparison of tuberculosis (TB) incidence rates between pilot project group and general population

Characteristics	Pilot project group			General population 2018
Characteristics	No. of participants	TB patients	Incidence rate (per 100,000 people)	No. of elderly	TB patients	Incidence rate (per 100,000 people)
Total	46,247^*	62	134	923,007^†	1,214	132
Chungcheongnam-do	15,345^*	17	111	376,206^†	409	109
Community	11,537	16	139	56,870	67	118
Asan	8,034	9	112	38,696	38	98
Taean	3,503	7	200	18,174	29	160
Long-term care facility	3,601	1	28	376,206	409	109
Other^‡	207	0	0	62,582	61	97
Jeollanam-do	15,084^*	17	113	414,749^†	609	147
Community	7,314	8	109	52,561	56	107
Suncheon	5,474	5	91	41,162	28	68
Hampyung	1,840	3	163	11,399	28	246
Long-term care facility	6,481	9	139	414,749	609	147
Other^‡	1,289	0	0	225,943	328	145
Gyeongsangbuk-do	15,818^*	28	177	132,052^†	196	148
Community	15,484	28	181	132,052	196	148
Gyeongju	7,143	14	196	53,147	79	149
Pohang	8,341	14	168	78,905	117	148
Long-term care facility	334	0	0	132,052	196	148

* Tuberculosis screening participants, 2019.

^† Number of elderly people aged 65 and over in the area of tuberculosis screening in 2019.

^‡ Tuberculosis screening is conducted for senior citizens of the community who wish to participate in tuberculosis screening projects in Chungcheongnam-do (3 area), Jeollanam-do (11 area)..

Table 5 Comparison of tuberculosis (TB) patients treatment rates between pilot project group and general population

Characteristics	Pilot project group		General population aged 65 years and over, 2018
Characteristics	n	%	n	%
No. of participants	74	100.0	12,652	100.0
Cured / Completed	61	82.4	9,645	76.2
Defaulted / Failed	3	4.1	131	1.0
Died	9	12.2	2,821	22.3
Under treatment	1	1.4	55	0.4

*Source: Integrated Disease and Health Control System – TB Control : http://is.cdc.go.kr.

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