我国法定报告传染病的健康危害程度综合评价

Comprehensive evaluation of health effect of notifiable infectious diseases in China

目的：探讨2004～2013年我国法定传染病健康危害程度及变化趋势，分析识别我国主要健康危害传染病，为解决我国主要健康问题相关政策的制订和资源的配置提供依据。方法采集、整合2004～2013年国家法定报告传染病监测数据。采用综合指数法，首次构建疾病健康危害度指数（HEI），合并疾病发病率和死亡率指标，综合评价疾病健康危害程度。采用描述性统计和单因素线性回归统计方法对HEI及其在2004～2013年的变化趋势进行分析。采用二维象限法识别健康危害程度严重（HEI较高）且增长趋势显著的传染病为我国主要健康危害传染病。结果2004～2013年我国传染病HEI前3位的依次为肺结核、病毒性肝炎、艾滋病（HEI=1.29、1.08、0.80）；HEI升高趋势显著且排名前3位的传染病依次是手足口病、艾滋病、梅毒（b=0.17、0.10、0.02，P〈0.05）。二维象限法识别结果显示，位于第Ⅱ象限（HEI〉极差/2且HEI增长趋势显著）的艾滋病，位于第Ⅳ象限（HEI〉极差/2）的肺结核和病毒性肝炎，以及位于第Ⅰ象限（HEI增长趋势显著）的手足口病和梅毒等是我国主要健康危害传染病。结论综合指数评价法和二维象限法可作为疾病健康危害程度评价识别的有效方法。当前和未来一段时间我国主要健康危害传染病为肺结核、病毒性肝炎、艾滋病、手足口病和梅毒。

Objective To investigate the degree and trend of health hazards of notifiable infectious diseases from 2004 to 2013 and to identify the key infectious diseases in the current and near future in China. This study almed to provide the evidence for the health policy making and health resources allocation. Methods The surveillance data of infectious diseases from 2004 to 2013 were collected from China CDC Information System. The comprehensive index method was used to combine the index mortality and morbidity, and then the health effect index （HEI） was first created to compre-hensively measure the hazard degree of the infectious diseases. Descriptive statistical analysis and regression analysis were used to investigate the characteristics and changing trend of the HEI over the past ten years. Two-dimensional quadrant method was used to identify the key infectious diseases that with high HEI and significant increased trend of the HEI. Results The infectious diseases with top 3 HEI were tuberculosis, viral hepatitis and alDS from 2004 to 2013, of which HEI were 1.29, 1.08 and 0.80 respectively. The infectious diseases, whose HEI increase most significantly, were hand foot and mouth diseases （HFMD）, alDS and syphilis （b=0.17, 0.09, 0.02, P〈0.05）. Results of two-dimensional quadrant method showed that alDS in quadrantII（HEI〉range/2 and increased significantly）, tuberculosis and viral hepatitis in quadrant Ⅳ （HEI〉range/2）, and HFMD, infectious diarrhea disease and syphilis in quadrant Ⅰ（HEI increased significantly）, which were all the key infectious diseases in China. Conclusion The comprehensive index method and two-dimensional quadrant method can be used to evaluate and identify health hazard degree effectively. The key infectious diseases in China are tuberculosis, viral hepatitis, alDS, HFMD, and syphilis in the current and near future.