2013-2017年广东省涂阳肺结核时空分布特征

Spatiotemporal characteristics on smear-positive pulmonary tuberculosis during 2013—2017 in Guangdong,China

目的分析2013-2017年广东省涂阳肺结核流行情况及时空分布特征.方法通过《中国疾病预防控制信息系统结核病管理信息系统》收集广东省2013-2017年涂阳肺结核患者信息,累计登记126848例.同期广东省各县(区)常住人口数据来自广东省各年度统计年鉴.以广东省矢量地图为空间结构数据库,并关联地理信息数据库和涂阳肺结核登记数据及人口数据.通过全局和局部空间自相关方法分析涂阳肺结核患者的空间聚集性.结果20132017年广东省涂阳肺结核年均登记率为24.1/10万.在县(区)级水平上,历年涂阳肺结核整体上均呈空间自相关性(MoranI值介于0.14~0.35之间),2017年聚集性最高(Moran I=0.35,Z=6.64,P=0.001).局部空间自相关分析发现,2013年和2014年涂阳肺结核的高-高聚集区在全省范围内散在分布,2015-2017年高-高聚集区大部分在珠江三角洲地区(简称“珠三角”)(以广州市为主).时空扫描统计分析显示,一级聚集区为2016年4月至2017年12月以珠海市香洲区为聚集中心的35个县(区)[对数似然比(log likelihood ratio,LLR)=358.47,相对危险度(relative risk,RR)=1.22,P<0.01];二级聚集区为2013年6月至2014年5月以湛江市遂溪县为中心的12个县(区)(LLR=338.33,RR=1.42,P<0.01)和2013年1月至2014年4月以揭阳市揭西县为中心的6个县(区)(LLR=211.34,RR=1.47,P<0.01).结论广东省各县(区)涂阳肺结核登记率整体呈空间聚集性分布,珠三角等人口密集、流动人口聚集的热点区域结核病传播风险高,应加强该地区结核病患者的治疗管理,防止向周边区域传播.

Objective To analyze the epidemiological condition and spatiotemporal characteristics of the smear-positive pulmonary tuberculosis(PTB)in Guangdong province from 2013 to 2017.Methods The information of the smear-positive PTB patients was collected by“China Disease Prevention and Control Information System and Tuberculosis Management Information System”in Guangdong province from 2013 to 2017,and accumulating 126848 cases were registered.In the same period,the resident population data of counties(districts)in Guangdong Province were from the annual statistical yearbooks of Guangdong Province.The vector map of Guangdong Province was used as the spatial structure database,and then the geographic information database was associated with the registration data of smear-positive PTB patients and population data.Spatial aggregation of the smear-positive PTB patients was explored by global and local spatial auto-correlation analysis.Results The average annual registration rate of smear-positive PTB patients was 24.1/100000 in Guangdong Province from 2013 to 2017.At the county(district)level,the smear-positive PTB showed spatial auto-correlation on the whole every year(Moran’s I value,0.14-0.35),with the highest aggregation in 2017(Moran’s I=0.35,Z=6.64,P=0.001).Local spatial auto-correlation analysis showed that the high-high clusters of smear-positive PTB patients were scattered throughout the province in 2013 and 2014,and the high-high clusters were mainly distributed in the Pearl River Delta(PRD)region during 2015-2017.Temporal and spatial scan analysis demonstrated that the primary cluster of which the center was Xiangzhou District of Zhuhai city covered 35 counties(districts)from April 2016 to December 2017(log likelihood ratio(LLR)=358.47,relative risk(RR)=1.22,P<0.01).The two secondary clusters of which the center was Suixi county of Zhanjiang city covered 12 counties(districts)from June 2013 to May 2014(LLR=338.33,RR=1.42,P<0.01),and of which the center was Jiexi county of Jieyang city covered 6 counties(districts)from January 2013 to April 2014(LLR=211.34,RR=1.47,P<0.01).Conclusion The registration rate of smear positive PTB in Guangdong province shows spatial clustering distribution on the whole.In hot spots with dense population and floating population,such as the PRD,the risk of PTB transmission is high.Therefore,the treatment and management of PTB patients in these regions should be strengthened,which can prevent PTB spread to surrounding areas.