[Analysis of the effectiveness of active screening for pulmonary tuberculosis among the elderly in Guizhou Province].

Objective: To analyze the effectiveness of active screening for tuberculosis among the elderly in Guizhou Province and provide a basis for optimizing screening strategies. Methods: Data on active screening for pulmonary tuberculosis among the elderly and case information were collected from the Guizhou Province Smart Disease Control Cloud System and the Tuberculosis Management Information System of the China Disease Prevention and Control Information System. The study analyzed the effectiveness of active screening and examined the basic information and clinical diagnostic characteristics of patients identified through different screening methods. The χ2 test was used for intergroup comparisons of rates or proportions, and the trend χ2 test was applied for temporal trends. The spatial distribution of screening detection rates was visualized using ArcGIS software. Results: From 2023 to 2025, a total of 7 966 965 chest X-ray screenings were conducted among the elderly in Guizhou Province, identifying 6 255 cases of tuberculosis, of which 4 467 were asymptomatic, representing an average annual proportion of asymptomatic cases of 71.4%. The detection rate from active screening rose from 65.3/100 000 in 2023 to 94.9/100 000 in 2025 (trend χ2=148.17, P<0.001). The detection rate from active screening was highest in Qiannan Buyi and Miao Autonomous Prefecture (Qiannan Prefecture) (124.4/100 000) and lowest in Qianxinan Buyi and Miao Autonomous Prefecture (44.8/100 000) (χ2=588.44, P<0.001). The proportion of patients identified through active screening in the nine cities (prefectures) ranged from 12.9% to 27.1%. Among them, the proportion of patients identified through active screening in Guiyang, Zunyi, Anshun, Liupanshui, Qiandongnan Miao and Dong Autonomous Prefecture, and Qiannan Prefecture all showed an upward trend (all P<0.05), while Bijie showed a downward trend (trend χ2=15.32, P<0.001). Among patients identified through active screening, males (62.6%), those aged 65-74 (62.8%), farmers (84.4%), and residents of rural areas (68.2%), a history of diabetes (8.9%), a history of tuberculosis (18.4%), the proportion of patients using fixed-dose combination antituberculosis regimens (70.4%), and the proportion of patients with positive microbiological test results (78.8%) were all higher than in passively identified patients (all P<0.001). The proportions of patients with delayed diagnosis (12.1%) and with adverse outcomes (11.6%) were both lower among those identified through active screening than among those identified through passive detection (both P<0.001). Active screening accounted for 18.4% of the total, with the highest contribution rates observed among men (19.3%), the 65-69 age group (19.5%), and Liupanshui City (26.5%) (all P<0.001). Conclusions: Active screening for tuberculosis among the elderly in Guizhou Province has achieved some success. However, it is still necessary to expand screening coverage, particularly by increasing participation among high-risk elderly populations. Efforts should be made to actively promote the application of new technologies to improve the accessibility and effectiveness of screening. At the same time, efforts should be made to increase the rate of successful referrals, reduce delays in seeking medical care, promptly identify patients, and effectively curb the transmission and spread of the disease.