南京地区肺结核发病率的 时空分布特征及与性别、年龄变化情况

Temporal spatial distribution and characteristics of tuberculosis incidence rate and gender and age changes in Nanjing

目的 调查并分析南京地区肺结核发病率的时空分布特征及性别、年龄变化情况。方法 选取2016—2020年在南京市定点医院登记的肺结核患者为研究对象。发病率的年变化趋势通过年估计变化百分比(estimated annual percent change,EAPC)进行评估。地区报告发病率根据2010年第六次全国人口普查南京市人口年龄进行标化。结果 2016—2020年南京市肺结核患者总计11406例,其中病原学阳性患者5023(44.04%)例,阴性患者5812(50.96%)例,利福平耐药患者285(2.50%)例,无病原学结果患者285(2.50%)例。肺结核发病率EAPC=-2.08%,即肺结核报告发病率总体呈下降趋势,但各年份的肺结核报告发病率比较差异无统计学意义(P>0.05)。各年份患者性别差异均无统计学意义(P均>0.05)。各年份按患者年龄分层后发现<15岁的患者发病率最低(0.07/10万~0.19/10万),25~34岁患者发病率最高(5.14/10万~5.71/10万)。标化后的各地区结核病发病率为18.80/10万~39.30/10万之间。居前3位的地区分别是高淳区(39.30/10万)、江宁区(35.50/10万)和江北新区(33.10/10万)。标化发病率较低的地区为秦淮区(18.80/10万)、鼓楼区(19.80/10万)、玄武区(19.80/10万);2016—2020年南京市各年度Moran指数I值分别为0.256、0.370、0.370、0.352和0.305,且差异均具有统计学意义(P均<0.05);局部空间自相关分析结果显示,2016—2020年分别有2、1、1、3、1个区(县)处于“高-高”(HH)区域。溧水区连续5年处于HH区域。浦口区分别在2016、2019年处于HH区域,建邺区、秦淮区在2017—2019年均处于“低-低”(LL)区域,栖霞区在2019年处于HH区域,鼓楼区在2019年处于LL区域。结论 2016—2020年间,南京市肺结核发病率呈下降趋势,各年度报告发病率呈显著的聚集性分布,在不同时空和年龄分布上存在较大差异。因此,我们应结合其流行病学特点,采取有效防控措施。

Objective To investigate and analyze the spatial and temporal distribution characteristics of tuberculosis incidence and its gender and age in Nanjing. Methods Pulmonary tuberculosis patients registered in designated hospitals in Nanjing from 2016-2020 were selected as the study subjects. Annual trends in incidence were assessed by estimated annual percent change(EAPC). Regional reported incidence was standardized according to the age of Nanjing population in the sixth national census in 2010.Results From 2016-2020, there were 11 406 tuberculosis patients in Nanjing, namely 5023 patients(44.04%) with positive etiology,5812 patients(50.96%) with negative etiology, 285 patients(2.50%) with resistant to rifampicin, and 285 patients(2.50%) without etiology results. The EAPC for tuberculosis incidence was-2.08%, which means the overall reported incidence of tuberculosis decreased,but the annual reported incidence of tuberculosis was not statistically significant from 2016-2020(P >0.05). And there was no significant difference between gender of tuberculosis patients(P >0.05). However, when patients were stratified by age, we found that the lowest incidence in patients < 15 years old(0.07/100 000 ~ 0.19/100 000) and the highest incidence in patients 25 to 34 years old(5.14/100 000 ~ 5.71/100 000). The standardized incidence of tuberculosis in each region was 18.80/100 000 ~ 39.30/100 000.The top 3 areas were Gaochun District(39.30/100 000), Jiangning District(35.50/100 000) and Jiangbei New Area(33.10/100 000). The areas with low standard incidence were Qinhuai District(18.80/100 000), Gulou District(19.80/100 000)and Xuanwu District(19.80/100 000);the Moran index I were 0.256, 0.370, 0.370, 0.370, 0.352 and 0.305 respectively, and the differences were significant(P <0.05);local spatial autocorrelation analysis showed that 2, 1, 1, 3, and 1 districts(countries) were in HH from 2016-2020. Lishui District was in the HH area for 5 consecutive years. Pukou District was in HH area in 2016、2019 respectively, Jianye District and Qinhuai District were in LL area in 2017-2019, Qixia District in HH area in 2019, and Gulou District in LL area in 2019. Conclusions From 2016-2020, the incidence of tuberculosis in Nanjing showed a decline, and incidence reported in each year showed a significant clustered distribution,and had great differences in different spatial, temporal and age distribution. Therefore, we should take effective prevention and control measures by combining its epidemiological characteristics.