应用空间扫描统计分析广东省出生缺陷分布

Application of flexible spatial scan statistc in analyzing birth defects in Guangdong Province

目的探索通过空间扫描分析获取出生缺陷致畸因子的线索,为致畸因素识别提供新的方法,为制定出生缺陷高发区域的综合防控措施提供参考。方法以2014年度广东省出生缺陷医院监测数据和2015年广东省统计年鉴中人口密度、工业企业单位数、工业废气排放总量和工业废水排放总量数据为研究资料,利用空间相关性统计方法和空间热点探测统计对聚集型和非聚集型出生缺陷进行空间相关性分析以及不同尺度的热点分析。结果广东省2014年出生缺陷医院监测系统监测围产儿244 363人,出生缺陷患儿7 638例,出生缺陷发生率为31.26‰。男性围产儿缺陷发生率为34.11‰,高于女性的27.69‰,产妇居住地为城镇的围产儿缺陷发生率为32.92‰,高于农村的29.82‰,<20岁和≥35岁产妇的围产儿缺陷发生率比其他年龄组的高。各地级市出生缺陷发生率差异较大(P<0.01)。空间扫描统计量分析发现全省出生缺陷的空间分布存在聚集性(P<0.05),深圳市、东莞市、珠海市、中山市、佛山市、广州市和揭阳市7个地市为聚集区域,聚集风险RR值为1.14~2.53,其余14个地市为非聚集区域。聚集区域的人口密度、工业企业单位数、工业废气排放总量及工业废水排放总量均高于非聚集区域(均P<0.05)。结论广东省围产儿出生缺陷区域高发,空间分布差异明显。在高发集中区域,应进一步加强出生缺陷与社会经济因素的相关性研究。

Objective To explore clues to teratogenic factors of birth defects using flexible spatial scan statistic, so as to provide a new method for identifying teratogenic factors and reference for strengthening the comprehensive prevention and control measures of birth defects. Methods Data of birth defects in 2014 were derived from the Birth Defects Surveillance System in Guangdong Province （BDSSGP）. Data of population density, industrial enterprises, waste gas emissions and waste water emissions were extracted from Guangdong Statistical Yearbook 2015. Spatial correlation and hot spot detection method of flexible spatial scan were used to observe the spatial clustering characters of birth defects and determine the rela-tionship between society-economic indexes and birth defects. Results A total of 7 638 cases of birth defects were observed among 244 363 cases of perinatal infants reported in BDSSGP in 2014, with an incidence rate of 31.26 per thousand. The incidence of birth defects in males was 34.11‰, higher than that in females （27.69%o）, and in urban area was 32.92%0, higher than that in rural area （29.82%0）. The incidence rates of birth defects in puerperants aged less than 20 years and 35 years or above were higher than those in other age groups. The incidence rates of birth defects varied greatly in prefecture-level cities （P 〈0.01）. Flexible spatial scan analysis showed that the spatial distribution of birth defects in the whole prov- ince was clustered （P 〈0.05）. Seven cities of Shenzhen, Dongguan, Zhuhai, Zhongshan, Foshan, Guangzhou, and Jieyang were highly clustered, with the RR values ranging from 1.14 to 2.53, while the rest of the 14 cities were not clustered. The population density, number of industrial enterprises, total amount of emission for industrial waste gases, total amount of industrial waste water discharge in clustered area were higher than those in non-clustered one （ all P 〈 0.05）. Conclusion The incidence of birth defects was high in some area with obvious spatial distribution in Guangdong Province. The correlation between birth defects and socio-economic factors should be further researched in clustered area.