山东省2015年肺结核发病时空特征分析

Spatial-temporal analysis of pulmonary tuberculosis in Shandong province, 2015

目的 分析山东省2015年活动性及痰涂片阳性（涂阳）肺结核发病的时空流行特征。方法 收集山东省2015年活动性及涂阳肺结核报告发病信息，以地理信息系统为基础，采用全局及局部空间自相关统计量（Moran’s I）分析肺结核发病的空间聚集性，采用SaTScan分析发病的时空聚集性。结果 2015年山东省共报告活动性及涂阳肺结核患者31 776例和8 631例，报告发病率分别为33.09/10万和8.99/10万。在县级水平上，活动性肺结核的发病整体上呈现空间自相关性（Moran’s I=0.219，P〈0.001），高发病-高聚集区为鲁西北、鲁东南和鲁中南地区；涂阳肺结核发病在整体分布上也呈现聚集型分布（Moran’s I=1.178，P〈0.001），高发病-高聚集区为鲁东南和鲁西北地区。时空扫描结果显示：活动性肺结核在第2、3季度存在发病聚集性，聚集区为鲁中南、鲁东南及鲁西北的部分县（区）；涂阳肺结核发病在2、3季度亦存在聚集性，聚集区域为鲁东南以及鲁西北的部分县（区）。结论 山东省2015年活动性及涂阳肺结核发病在整体上均呈现空间聚集性；鲁西北、鲁东南地区是肺结核高负担聚集区同时也是传播高风险聚集区，鲁中南地区是肺结核高负担但非高风险传播聚集区。

Objective To analyze the spatial-temporal epidemiological characteristics of active pulmonary tuberculosis （PTB） and sputum smear positive （SS＋） PTB in Shandong province, China, 2015. Methods The surveillance data of active PTB and SS＋PTB in Shandong in 2015 were collected and analyzed by using the global and local indicators of spatial association （Moran＇s I） for the spatial autocorrelation of PTB, and by using SaTScan forspatial-temporal clustering characteristics of PTB based on geographic information system. Results Totally, 31 776 active PTB cases and 8 631 SS＋PTB cases were reported in Shandong in 2015, and the reported incidence rates of active PTB and SS＋PTB were 33.09/100 000 and 8.99/100 000, respectively. Active PTB had positive spatial autocorrelation at county level, and the value of Moran＇s I value was 0.219 （P〈0.001）, indicating that the high-high （HH） aggregation areas with high incidence were in the northwestern, southeastern and central southern Shandong; SS＋PTB also had positive spatial autocorrelation at county level, and the value of the Moran＇s I was 1.178 （P〈0.001）, indicating that the HH aggregation areas with high incidence were in the southeastern and northwestern Shandong. The results of spatial-temporal scanning indicated that there was incidence clustering of active PTB in the second quarter and the third quarter in 2015, and the clustering areas were in the central southern, southeastern and northwestern Shandong; there also was incidence clustering of SS＋PTB in the second quarter and the third quarter in 2015, and the clustering areas were in the southeastern and northwestern Shandong. Conclusions The incidence of active PTB and SS＋PTB showed spatial and temporal clustering in Shandong in 2015. The areas with high PTB burden and high PTB transmission risks were in the northwestern and southeastern Shandong. The areas with high PTB burden but without high PTB transmission risks were in the central southern Shandong.