title: Integrating tuberculosis screening into annual health examinations for the rural elderly improves case detection.
abstract: OBJECTIVE
  To assess the feasibility and effects of identifying tuberculosis (TB) cases by integrating TB screening into routine health examinations for the elderly in rural China.
  
  
  METHODS
  Three counties in Shandong Province were randomly selected for TB screening among three groups of elderly individuals (aged ⩾60 years) at high risk for TB: 1) those with symptoms of TB, 2) patients with type 2 diabetes mellitus (DM), and 3) close contacts of TB cases. Individuals with X-rays suggestive of TB were referred to the county TB dispensary for further investigation.
  
  
  RESULTS
  Among the 93 094 elderly residents who underwent health examinations, 9044 (9.7%) were identified as high risk for TB. TB detection rates were 0.87 per 1000 among those who showed TB symptoms only and 3.36/1000 among those with DM only; however, the rate was significantly higher (115/1000) among those who had both DM and TB symptoms. No TB cases were identified from the close contacts group.
  
  
  CONCLUSIONS
  Integrating TB screening into annual health examinations for the elderly in rural areas was effective in identifying new cases, especially among elderly DM patients with TB symptoms.
authors.affiliation: Centre for Tuberculosis Control, Shandong Provincial Chest Hospital, Jinan, China.
authors.forename: X-L
authors.initials: XL
authors.lastname: Zhang
authors.affiliation: Centre for Tuberculosis Control, Shandong Provincial Chest Hospital, Jinan, China.
authors.forename: S-G
authors.initials: SG
authors.lastname: Li
authors.affiliation: Centre for Tuberculosis Control, Shandong Provincial Chest Hospital, Jinan, China.
authors.forename: H-T
authors.initials: HT
authors.lastname: Li
authors.affiliation: Oncology Department, Affiliated Hospital to Weifang Medical University, Weifang, China.
authors.forename: G-X
authors.initials: GX
authors.lastname: Li
authors.affiliation: Centre for Tuberculosis Control, Shandong Provincial Chest Hospital, Jinan, China.
authors.forename: X-Y
authors.initials: XY
authors.lastname: Guo
authors.affiliation: Centre for Tuberculosis Control, Shandong Provincial Chest Hospital, Jinan, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Centre for Tuberculosis Control, Shandong Provincial Chest Hospital, Jinan, China.
authors.forename: R
authors.initials: R
authors.lastname: Li
authors.affiliation: School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: J
authors.initials: J
authors.lastname: Yin
authors.affiliation: Comdis Health Service Delivery China Office, Nuffield Centre for International Health and Development, University of Leeds, Shenzhen, China.
authors.forename: G-Y
authors.initials: GY
authors.lastname: Zou
authors.affiliation: School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Comdis Health Service Delivery China Office, Nuffield Centre for International Health and Development, University of Leeds, Shenzhen, China.
authors.forename: X-L
authors.initials: XL
authors.lastname: Wei
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002681:China; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010808:Physical Examination; D011859:Radiography; D012424:Rural Population; D014376:Tuberculosis / Q000000981:diagnostic imaging* / Q000453:epidemiology