2015—2018年南宁市学生肺结核空间分布及影响因素分析

Analysis on the spatial distribution and influencing factors of pulmonary tuberculosis among students in Nanning from 2015 to 2018

目的了解南宁市在校中小学生及大学生肺结核的流行特征,分析空间效应影响下影响因素的作用机制,为制定肺结核防控措施提供参考。方法通过空间扫描统计分析南宁市学生肺结核乡镇级别的报告发病情况,以描述疾病的空间聚集情况。并基于南宁市区县级别空间面板数据建立空间杜宾模型分析空间效应及影响因素。结果2015―2018年南宁市学生肺结核报告发病率总体呈增长趋势,病例年龄段主要集中在16~22岁。报告发病高峰期为3―5月和9―11月,低谷期为2月和6―7月。空间扫描分析发现学生肺结核的高发地区分布于市区中心及其周围地区,如朝阳街道、建政街道和华强街道。空间分布格局以六城区交界处为中心向周围的地区扩散,聚集热度也由中心向周围逐渐降低。影响因素分析发现各因素对报告发病率的影响受到空间效应的作用,其中大学生人口密度具有正向影响,人均卫生财政支出具有负向影响,人均国内生产总值(gross domestic product,GDP)具有间接效应,而每千人口卫生技术人员数既具有直接效应又具有间接效应。结论南宁市学生肺结核存在空间聚集,主要位于市区中心及其周围地区,报告发病率受到空间效应的作用。

Objective To understand the epidemiological characteristics of pulmonary tuberculosis among students in Nanning,and to analyze the mechanism of the influencing factors under the influence of spatial effects,and to provide reference for the development of pulmonary tuberculosis prevention and control measures.Methods The reported incidence of pulmonary tuberculosis among students in Nanning at the township level was statistically analyzed by spatial scan to describe the spatial clustering of the disease.And the Spatial Durbin Model was established to analyze the spatial effects and influencing factors based on the spatial panel data at the district and county levels in Nanning.Results The reported incidence of pulmonary tuberculosis among students in Nanning showed an overall increasing trend from 2015 to 2018.The age of the cases was mainly between 16 and 22 years old.The peak periods of reported cases were from March to May and from September to November,and the trough periods were February and from June to July.Spatial scan analysis revealed that the high incidence of pulmonary tuberculosis among students was distributed in the urban center and its surrounding areas,such as Chaoyang Street,Jianzheng Street,and Huaqiang Street.The spatial distribution pattern was centered on the junction of the six urban areas as the center spreading to the surrounding areas,and the heat of gathering gradually decreasing from the center to the surrounding areas.The analysis of influencing factors found that the influence of each factor on reported incidence was subject to spatial effects.Among them,population density of college students had a positive effect,per capita health financial expenditure had a negative effect,per capita GDP had an indirect effect,and number of health technicians per 1000 had both a direct and an indirect effect.Conclusions There is a spatial clustering of pulmonary tuberculosis among students in Nanning,mainly located in and around the urban center.The reported incidence rate is subject to spatial effects.