血吸虫病疾病负担研究Ⅳ慢性血吸虫病的社区危险因素

Burden of disease in schistosomiasis japonica Ⅳ Community socioeconomic determinants of chronic schistosomiasis

目的探讨湖沼型流行区社区水平(村级)卫生经济因素与慢性血吸虫病疾病负担的关系。方法收集2004-2005年安徽当涂县和湖南汉寿县以行政村为单位的社会经济学资料,建立慢性血吸虫病疾病负担伤残调整寿命年(Years lived with disability,YLDs)数据。以每村家庭第一主成分的中位数代表各村的经济发展水平,对中位数进行排序,并分成5等分,再计算两个县YLDs的经济集中指数;以各样本村的每千人口YLDs为因变量,用多元回归分析对经济水平、安全饮水、卫生厕所、村与疫水的平均距离等社区卫生经济进行多因素分析。结果当涂县和汉寿县YLDs的集中指数分别为-0.12和0.03,YLDs在村级经济水平间分布均衡;当涂县与汉寿县社区经济"最差、较差、中等、较好、最好"分类的每千人YLDs分别为5.87、4.43、3.38、0.76人年/1000人和0.76人年/1000人与5.38、11.80、5.17、8.19人年/1000人和9.58人年/1000人,2个县村级经济水平与血吸虫病疾病负担呈非线性关系。多元回归分析显示,行政村离疫水越远,YLDs越小(P<0.01),人均水田面积越多YLDs越大(P<0.05)。结论社区经济水平与血吸虫病疾病负担呈非线性关系,但村与疫水距离、种植水田的面积与居民疾病负担关系密切。

Objective To explore the socioeconomic determinants of chronic schistosomiasis japonica at a community （village） level. Methods The socioeconomic and epidemiological data （Years lived with disability, YLDs） came from the thematic research carried out in two schistosome-endemic counties, Dangtu and Hanshou, in lake areas between 2004 and 2005. A concentration index was calculated and used to assess the health inequalities between socioeconomic statuses. The community risk factors relating to chronic schistosomiasis were explored by the multiple regression model. Results The concentration index was -0.12 of Dangtu County and 0.03 of Hanshou County which indicated that there were no health inequalities due to schistosomiasis between communities with different socioeconomic statuses. There was no linear relationship between the economic levels and YLDs of chronic schistosomiasis. The results of multiple regression model showed that the distance from village to schistosome-infested water （P 0.01） and wet land area per capita （P 0.05） were significantly related to YLDs of chronic schistosomiasis. Conclusion There is non-linear relationship between socioeconomic levels and YLDs of chronic schistosomiasis, but the distance from village to schistosome-infested water and wet land area per capita are significantly related to the latter.