基于乡镇尺度的云南省保山市乙型肝炎时空流行特征分析

Spatiotemporal characteristics of hepatitis B based on township scale in Baoshan City,Yunnan Province

目的掌握保山市乙型肝炎(乙肝)疫情的流行病学特征,为乙肝防控提供科学依据。方法运用Excel 2007及SPSS 19.0软件进行描述性流行病学分析,采用开源软件GeoDa 1.8.0软件进行于空间自相关分析以及SaTScan 9.6软件开展回顾性时间扫描统计,同时运用ArcGIS 10.5软件绘制各乡镇乙肝年均发病率和急性乙肝年均发病率分布图以及发病风险图。结果2005-2018年云南省保山市共报告乙肝患者18467例,年平均发病率为52.30/10万。病例主要集中在青年男性农民;男性发病率高于女性,差异有统计学意义(P<0.001)。每月均有病例报告,无明显的季节发病高峰。隆阳区乙肝报告病例数最多且发病率最高,空间自相关提示乙肝发病在乡镇尺度上存在空间聚集性;空间扫描统计量显示空间聚集区位于保山东北地区,空间聚集区以杨柳乡为中心,聚集半径为31.46 km,聚集区覆盖保山市区及周边地区等12个乡镇或街道办,聚集区内的乙肝发病风险(RR)是聚集区外的2.26倍。急性乙肝发病率的空间自相关系数Moran’s I为0.40;急性乙肝发病主要聚集在碧寨乡等保山西南部地区19个乡镇,聚集半径为38.92 km,聚集区内的发病风险是聚集区外的1.82倍。结论保山市部分乡镇乙肝和急性乙肝发病率高,且乙肝和急性乙肝发病在乡镇尺度上均存在热点地区,热点地区存在空间分异性。今后应根据本市乙肝流行特征,深入开展乙肝空间分异质性的影响因素研究。

Objective To understand the epidemiological characteristics of acute and chronic hepatitis B in Baoshan city,Yunnan province,and provide scientific evidence for the prevention and control of hepatitis B.Methods Excel 2007 and SPSS 19.0 were used for descriptive epidemiological analysis.GeoDa 1.8.0 was used for spatial autocorrelation analysis and SaTScan 9.6 software was used for retrospective time scan statistics.ArcGIS 10.5 software was used to generate the average annual incidence and the distribution of the average annual incidence of acute and chronic hepatitis B and the incidence risk charts of each township.Results A total of 18467 HBV cases were reported with an annual average incidence of 52.30/100000.Most cases were young and middle-aged male farmers.The incidence rate in males was higher than that in females(P<0.001).Temporally,hepatitis B cases were reported in each month without obvious seasonal incidence peak.Spatially,the highest case number and incidence rate were reported in Longyang district with a spatial autocorrelation coefficient of 0.54.A spatial cluster was founded in the northeast areas covering 12 townships with a radius of 31.46,and Yangliu Township was the center of spatial cluster with a radius of 31.46 km and a relative risk(RR)of 2.26.The coefficient of spatial autocorrelation(Moran’s I)of acute hepatitis B incidence rate was 4.0.The cluster of acute hepatitis B cases was mainly found in 19 townships in the southwest area in Baoshan,including Bizai,with a radius of 38.92 km and a RR of 1.82.Conclusion The incidence rates of hepatitis B in some townships of Baoshan were high,and hot areas with high incidence rates existed at the township level.The variation in hot area spatial distribution also existed.Factors associated with the variation of spatial distribution of hepatitis B in Baoshan need to be further studied.