2004~2017年中国大陆AIDS疫情时空分布特征分析

Temporal-spatial Characteristic Analysis of AIDS Epidemic During 2004~2017 in China's Mainland

目的研究2004~2017年全国不同地区(不含港澳台地区)获得性免疫缺陷综合症(acquired immune deficiency syridrome,AIDS)发病率时空变化特性,为预防和控制AIDS提供参考依据。方法收集中国疾病预防控制中心公共卫生科学数据中心和国家统计局中国统计年鉴的关于AIDS流行病学数据;采用Joinpoint模型、时间序列分析及空间分析的描述性流行病学方法分析AIDS的时空特点。结果Joinpoint最终选择模型为1分段点模型(P=0.11),分段点为2012年:其中2004~2012年和2012~2017年年度变化百分比分别为34.7%和9.4%;2004~2017年年度变化百分比为24.3%。构建的最佳季节差分自回归综合移动平均模型为(2,1,0)(2,1,0)12,该模型拥有最小的赤池信息量准则和贝叶斯信息度量准则分别为64.92和70.85。2004~2008年国内所有省份的AIDS发病率均小于50/百万,广西和云南自2012~2017年连续5年发病率大于100/百万,是我国AIDS发病率最高的两个省份。AIDS传播热点主要集中在我国西南地区,包括广西、云南、贵州、四川和重庆,该区域主要为高-高聚集。结论目前中国AIDS发病率较高且仍处于快速上升的阶段,今后应重点关注广西、云南、贵州、四川、新疆和重庆六省市的AIDS发病情况,既要做到区域内防控,也要防止其向周边扩散。

Objective To study the temporal and spatial variation characteristics of the incidence of AIDS in different areas of China(except of Hong Kong,Macao and Taiwan)from 2004 to 2017,provide reference to prevent and control AIDS.Methods The data of AIDS from January 2004 to December 2017 were obtained from the notifiable infectious disease reporting system supplied by the Chinese Center for Disease Control and Prevention.The population size was easy to find in the website.The incidence trend of AIDS was observed by the Joinpoint regression analysis.The seasonal autoregressive integrated moving average(SARIMA)model was used to predict the monthly incidence.Geographic clusters was employed to analyze the spatial autocorrelation.The relative importance component of AIDS was detected by the multivariate time series model.All the data were analyzed with descriptive statistics.Results The final selected model was the Joinpoint model(P=0.11),the break point was 2012.The average percentage change(APC)was 34.7%from 2004 to 2012,and 9.4%from 2012 to 2017.The annual APC rate of the fourteen years was 24.3%.The best SARMA model was(2,1,0)(2,1,0)12 with the smallest AIC(64.92)and BIC(70.85).From 2004 to 2008,the reported incidence rate was less than 50/1000000 among all provinces in China.Guangxi and Yunnan had more than 100/1000000 patients for seven consecutive years since 2012,which were dominant in China.AIDS transmission hotspots were mainly concentrated in southwest China,including Guangxi,Yunnan,Guizhou and Sichuan,which was mainly High-High Cluster.Conclusion At present,the incidence of AIDS in China is high and still in the stage of rapid development.The provinces with high incidence of AIDS will be mainly concentrated in Guangxi,Yunnan,Sichuan,Xinjiang,Guizhou and Chongqing.In the future prevention and control,we should focus on these key provinces to achieve provincial prevention and control and to prevent its spread to its surrounding areas.