基于可变形空间扫描统计量法的四川省肺结核聚集性探测研究

A Clustering Study on Pulmonary Tuberculosis in Sichuan Province Based on Flexibly Shaped Spatial Scan Statistics

目的探索2016-2018年四川省肺结核发病的空间聚集性,识别重点防控区域及其变化趋势。方法基于2016-2018年中国疾病预防控制信息系统传染病报告信息管理系统中四川省181个县区肺结核疫情数据和人口数据,建立地理信息数据库,采用FleXScan 3. 1. 2软件探测肺结核发病聚集区域,通过ArcGIS 10. 2软件进行可视化。结果 2016-2018年四川省肺结核报告发病率从66. 29/10万下降至57. 34/10万,处于增长和递降趋势的分别有58和123个县区。全省肺结核疫情呈明显的聚集性分布,在2016-2018年分别探测到了13、10和10个形状不规则的肺结核发病空间聚集区(P<0. 05)。连续3年处于一级聚集区的10个县位于大、小凉山地区,即彝族聚居区,对数似然比(log-likelihood ratio,LLR)分别为1 841. 61、2 612. 74和2 618. 96。连续3年处于二级聚集区的县位于川西高原阿坝、甘孜民族地区,LLR值分别为1 051. 39、1 736. 55和1 667. 63。秦巴山区的大部分县也均连续3年处于聚集性区域。结论四川省肺结核疫情存在明显的空间聚集性,大、小凉山地区、川西高原少数民族地区和秦巴山区是高风险和重点防控区域,应实施针对性强的区域结核病防治策略和政策支持。

Objective To explore the spatial distribution and trends of pulmonary tuberculosis( PTB) in Sichuan province from 2016 to 2018,so as to identify key areas for disease prevention and control. Methods Geographic information database was established by using the incidence data of PTB and demographic data reported in the China Disease Prevention of Infectious Disease Reporting Information Management System in Sichuan province from 2016 to 2018,spatial clustering analysis were conducted with software FleXScan 3. 1. 2 to determine high risk areas of PTB,visualized by the software ArcGIS 10. 2. Results The incidence rate of PTB during the year 2016-2018 in Sichuan decreased from 66. 29/105 to 57. 34/105. There were 58 and 123 counties of which the incidence rate were in a increasing and decreasing trend,respectively. There were obvious clusterings for the incidence rate of each year from 2016 to 2018,with 13,10 and 10 irregular shaped clusterings of the epidemic of PTB( P<0. 05) detected in the 3 years,respectively. The 10 counties that have been in the first-class clustering region for three consecutive years were located in the Liangshan Yi areas. The log-likelihood ratio( LLR) was 1 841. 61,2 612. 74 and 2 618. 96,respectively. The counties that have been in the second-level clusterings for three consecutive years were located in Aba and Ganzi ethnic areas of the western Sichuan plateau,with LLR values of 1 051. 39,1 736. 55 and 1 667. 63,respectively. In addition,most of the counties in Qin Ba Mountains have been in the clustering areas for 3 consecutive years.Conclusion Obvious spatial temporal clustering of PTB distribution was found in Sichuan,especially in ethnic minority areas in the western Sichuan plateau,Liangshan Yi area and Qin Ba mountain area,where TB control strategies and policy support should be targeted.