2011-2018年中国手足口病发病的时空特征及影响因素研究

Spatiotemporal characteristics of hand,foot and mouth disease and influencing factors in China from 2011 to 2018

目的分析我国手足口病的时空特征,探讨社会、经济、人口和卫生服务等因素对我国手足口病发病的影响,为手足口病疫情防控提供参考依据。方法采用贝叶斯时空模型对手足口病数据进行拟合,评估手足口病的时空变化,并识别手足口病发病风险与社会、经济、人口和卫生服务等因素的潜在关联。结果2011-2018年,我国共报告手足口病例17118050例,死亡2283例,2011-2014年报告发病率呈波动上升趋势,2014-2018年报告发病率呈波动下降趋势,报告死亡率一直呈波动下降趋势。手足口病的发病具有空间聚集性,报告发病率最高的地区为华南地区且为热点区域及高风险区域,报告发病率最低的为西北地区,冷点区域及低风险区域也集中在其部分区域。手足口病发病风险与人均地区生产总值(RR=3.54)、每万人规模以上工业企业单位数(RR=1.61)、城市化率(RR=3.00)、人口出生率(RR=2.36)、每万人医疗机构床位数(RR=3.40)和人均公园绿地面积(RR=0.57)有关。结论2011-2018年我国手足口病防控重点区域为东南沿海地区,在加快城市化进程的同时需考虑增加人均公园绿地面积,以降低手足口病的发病率。

Objective To analyze the spatiotemporal characteristics of hand,foot and mouth disease(HFMD)in China,explore the association of socioeconomic,population and health services factors with the incidence of HFMD in China,and provide information for the prevention and control of HFMD.Methods Bayesian spatiotemporal model was used to fit the data of HFMD,evaluate the spatiotemporal variation of HFMD,and identify the potential association between the risk of HFMD and social,economic,population and health services.Results From 2011 to 2018,a total of 17118050 HFMD cases,including 2283 deaths,were reported in China.The reported incidence showed a fluctuating increase trend from 2011 to 2014,and a fluctuating decrease trend from 2014 to 2018.Meanwhile,there was a fluctuating decrease trend of mortality rate.The incidence of HFMD had spatial clustering,with the highest incidence in southern China with hot spot and high risk areas,and the lowest incidence in northwestern China where cold spot and low risk areas were found.The risk for HFMD was associated with GDP per capita(RR=3.54),number of industrial enterprises above designated size of 10000 people(RR=1.61),urbanization rate(RR=3.00),birth rate(RR=2.36),number of beds in medical institutions per 10000 people(RR=3.40),and green area in parks per capita(RR=0.57).Conclusions The hotspot area for HFMD prevention and control in China was in the southeast coastal provinces from 2011 to 2018.In order to reduce the incidence of HFMD,it is necessary to increase the green area in parks per capita while accelerating urbanization process.