中国典型法定报告传染病发病率空间关联性分析

Spatial correlation of incidence rate of typical notifiable infectious diseases in China

目的分析中国31个省、市、自治区典型法定报告传染病(甲型肝炎、乙型肝炎、丙型肝炎、戊型肝炎、肺结核、梅毒)发病率的空间分布特征及空间关联性,为制定区域化防控策略提供参考依据。方法收集2012—2014年《中国卫生和计划生育统计年鉴》和国家卫生计生委年度全国法定传染病疫情通报中甲型肝炎、乙型肝炎、丙型肝炎、戊型肝炎、肺结核、梅毒的发病资料进行趋势分析,应用分级地图展示2014年各传染病发病率,并综合运用全局和局部空间自相关分析方法探讨2014年传染病发病率的空间关联性和空间集聚特征。结果中国2012—2014年甲型肝炎发病率呈先下降后上升趋势,乙型肝炎和肺结核发病率呈下降趋势,丙型肝炎、戊型肝炎和梅毒发病率则呈波动趋势,但差异均无统计学意义(均P>0.05)。全局空间自相关分析结果显示,肺结核发病率的空间关联性最高,Moran’s I达0.437;梅毒发病率的空间关联性最低,Moran’s I仅为0.086;甲型肝炎、乙型肝炎、丙型肝炎和戊型肝炎发病率的Moran’s I为0.237~0.289。局部空间自相关分析结果显示,甲型肝炎和肺结核发病率在新疆、青海、西藏呈现高高集聚特征;丙型肝炎发病率在甘肃呈现高高集聚特征;戊型肝炎发病率在湖南、安徽、浙江呈现高高集聚特征,在山西、辽宁呈现高低集聚特征。结论肺结核发病率的空间关联性最高,梅毒发病率的空间关联性最低,应根据传染病的空间分布特征制定区域化防控措施,着重保护处于特定病种高发区域周围的弱势地区。

Objective To analyze spatial distribution characteristics and spatial correlation of incidence rate of typical notifiable infectious diseases （hepatitis A, hepatitis B, hepatitis C, hepatitis D, tuberculosis, syphilis）, and to provide a basis for formulating regional prevention and control measures.Methods We collected the data on incidence rates and cases of hepatitis A, hepatitis B, hepatitis C, hepatitis D, tuberculosis, and syphilis between 2012 and 2014 from Health and Family Planning Yearbook of China and Annual National Report on Notifiable Infectious Diseases issued by National Health and Family Planning Commission of People＇s Republic of China. Hierarchical map was used to display the incidence rates of the infectious diseases in 2014 and global and local spatial autocorrelation were used to identify the spatial correlation and spatial cluster features of the rates in 2014.Results During the 3-year period, the incidence of hepatitis A first decreased then increased;the incidence of hepatitis B and pulmonary tuberculosis declined obviously; and the incidence of hepatitis C, syphilis and hepatitis E showed a trend of fluctuation. The results of global spatial autocorrelation revealed the strongest spatial correlation （Moran＇s I = 0.437） in the incidence of pulmonary tuberculosis and the weakest in that of syphilis （Moran＇s I = 0.086）; while the correlation intensity of the four types of hepatitis was not quite different, with their Moran＇s I ranging from 0.23 to 0.29. The results of local spatial autocorrelation showed that the incidence of hepatitis A and pulmonary tuberculosis showed a high-high cluster feature in Xinjiang Uygur Autonomous Region, Qinghai province, and Tibet Autonomous Region; the incidence of hepatitis C showed a high-high cluster feature in Gansu province; the incidence of hepatitis E presented a high-high cluster feature in Zhejiang, Hunan and Anhui province, but a high-low cluster feature in Shanxi and Liaoning province.Conclusion From 2012 to 2014, the incidence of pulmonary tuberculosis showed the strongest spatial correlation, while the incidence of syphilis showed the weakest in China. The government agencies should formulate regional prevention and control measures based on the spatial distribution characteristics of the infectious diseases and pay special attention to the prevention of specific diseases in low incidence areas around the high incidence areas.