中国大陆地区2008—2013年丙肝发病时空聚集性及社会经济影响因素

Temporal-spatial clustering and socio-economic influencing factors of hepatitis C in China's Mainland,2008-2013

目的了解中国大陆地区2008—2013年丙肝发病时空聚集情况及其社会经济影响因素,为识别其早期暴发的时空分布、变化趋势以及制定丙肝防治策略提供参考依据。方法收集中国大陆地区31个省2008年1月1日—2013年12月31日丙肝发病监测数据,在市级水平以月为单位,采用Sa TScanTM9.1软件中Possion模型进行时空扫描分析,并应用地理加权回归模型分析其相关社会经济影响因素。结果中国大陆地区2008—2013年丙肝发病率为12.834/10万,2008—2013年丙肝发病率依次为8.975/10万、10.611/10万、12.256/10万、13.628/10万、15.581/10万、15.723/10万,差异无统计学意义(P>0.05);时空扫描分析结果显示,中国大陆地区丙肝发病存在明显的时空聚集性,2008—2013年依次有4、7、4、4、5、6个聚集区,主要集中区域分布在新疆、内蒙古、西藏、甘肃、青海、山西、河南、辽宁、河北、广东等省所辖市,聚集时间各有不同;2008和2009年主要聚集区域类似,2010—2013年主要聚集区域发生变化,1类聚集区域成为2类聚集区域,2类聚集区域成为1类聚集区域,3类聚集区域逐年缩小,4类聚集区域逐年扩大;地理加权回归分析结果显示,城镇居民人均可支配收入和农民人均纯收入2个社会经济影响因素对丙肝发病解释能力随地理位置不同而变化。结论中国大陆地区2008—2013年丙肝发病存在时空聚集性,城镇居民人均可支配收入和农村人均纯收入2个社会经济因素在不同的空间地理位置的对丙肝发病的影响不同。

Objective To examine temporal and spatial clustering and socio-economic influencing factors of hepatitis C epidemics in China's Mainland from 2008 to 2013,and to provide references for early identification and control of hepatitis C epidemics. Methods Possion model of Sa TScanTM9. 1 software was used to conduct monthly temporal and municipality-based spatial scanning analyses on hepatitis C incidence surveillance data during 2008- 2013 in China's Mainland and geographically weighted regression（ GWR） was applied to examine socio-economic influencing factors related to hepatitis C incidences. Results The average annual incidence of hepatitis C was 12. 834 /100 000 in China's Mainland during the 6-year period,with the yearly incidences of 8. 975,10. 611,12. 256,13. 628,15. 581,and 15. 723 /100 000 from2008 to 2013,respectively,and no statistically significant change trend in the annual incidence was observed（ X2trend= 1. 672,P = 0. 095）. Temporal and spatial scanning analyses revealed obvious temporal and spatial clustering of hepatitis C incidence in China's Mainland; the numbers of clustering areas were 4,7,4,4,5,and 6 for the years from 2008 to 2013 and the main clustering areas included Xinjiang Uygur,Inner M ongolia,and Tibet Autonomous Regions and Gansu,Qinghai,Shanxi,Henan,Liaoning,Hebei,and Guangdong provinces,respectively. The scopes of main clustering areas were similar from 2008 to 2009,but changed from 2010 to 2013,with the interchanging between the clustering areas of class 1 and 2,the shrinking of class 3 clustering areas,and yearly expanding of class 4 clustering areas. GWR results showed that the explanatory power of disposable income per capita in urban residents and net income per capita in rural residents on regional hepatitis C incidence differed by geographical location of the area. Conclusion Temporal and spatial clustering of hepatitis C incidence exist in China's Mainland from 2008 to 2013 and the effect of disposable income per capita in urban residents and net income per capita in rural residents on the incidence is different in various geographical areas.