基于Joinpoint回归模型的1999-2020全国血吸虫病流行趋势分析

Trends in prevalence of schistosomiasis in China from 1999 to 2020 based on Joinpoint regression model

目的了解1999-2020年全国血吸虫病流行趋势变化,为制定消除血吸虫病策略提供科学依据。方法收集1999-2020年全国血吸虫病疫情年报数据,采用Joinpoint回归模型,利用年均百分比变化(average annual percent change,AAPC)、年度百分比变化(annual percent change,APC)评价整体、局部血吸虫病疫情时间序列趋势变化。结果2002-2020年全国居民血检阳性率年均下降8.60%(AAPC=-8.60%,P<0.05),在2008年出现1个拐点,分为2个阶段,2002-2008年和2008-2020年(APC=-12.67%,P<0.05);1999-2020年居民粪检阳性率年均下降14.10%(AAPC=-14.10%,P<0.05),在2007年出现1个拐点,分为2个阶段,1999-2007年(APC=14.50%,P<0.05)和2007-2020年(APC=-28.01%,P<0.05)。1999-2012年耕牛阳性率年均下降13.20%(AAPC=-13.20%,P<0.05),在2004年出现1个拐点,分为2个阶段,1999-2004年和2004-2012年(APC=-22.42%,P<0.05);2013-2020年耕牛粪检阳性率逐年下降(APC=AAPC=-19.69%,P<0.05)。1999-2020年查出钉螺面积占查螺总面积比例年均上升1.5%(AAPC=1.5%,P>0.05),在2004年出现1个拐点,分为2000-2004年(APC=35.02%,P<0.05)和2004-2020年(APC=-0.08%,P<0.05);2000-2020年湖沼型流行区有螺面积占有螺总面积比例年均无变化(AAPC=0%,P>0.05),在2013年有1个拐点,分为2个阶段,2000-2013年(APC=0.16%,P<0.05)和2013-2020年(APC=-0.35%,P<0.05);水网型流行区有螺面积占有螺总面积比例年均下降14.7%(AAPC=-14.7%,P<0.05),在2007年出现1个拐点,分为2个阶段,2000-2013年和2013-2020年(APC=-34.36%,P<0.05);山丘型流行区有螺面积占有螺总面积比例有3个趋势变化连接点(AAPC=1%,P>0.05),分为4个阶段,分别为2000-2005年、2005-2014年(APC=-5.12%,P<0.05),2014-2017年(APC=19.53%,P<0.05)和2017-2020年。结论1999-2020年全国血吸虫病疫情呈下降趋势,在迈向消除阶段应继续采取以传染源控制为主的综合性防冶策略。

Objective To investigate the trends in prevalence of schistosomiasis in China from 1999 to 2020,so as to provide the scientific evidence for forumalting the schistosomiasis elimination strategy in China.Methods The annual data of schistosomisis epidemics were collected in China from 1999 to 2020,and the overall and local changes in the prevalence of schistosomiasis were evaluated with average annual percent changes(AAPC)and annual percent change(APC)using the Joinpoint regression model.Results There was a 8.60%annual mean reduction in seroprevalence of human schistosomiasis in China from 2002 to 2020(AAPC=-8.60%,P<0.05)from 2002 to 2020,with a turning point found in 2008(2002-2008;2008-2020:APC=-12.67%,P<0.05),and there was a 14.10%annual mean reduction in egg-positive rate of human schistosomiasis in China from 1999 to 2020(AAPC=-14.10%,P<0.05),with a turning point found in 2007(1999-2007:APC=14.50%,P<0.05;2007-2020:APC=-28.01%,P<0.05).There was a 13.20%annual mean reduction in the prevalence of schistosomiasis in bovines in China(AAPC=-13.20%,P<0.05)during the period from 1999 to 2012,with a turning point found in 2004(1999-2004;2004-2012:APC=-22.42%,P<0.05),and the prevalence of schistosomiasis appeared a gradual decline in bovines year by year from 2013 to 2020(APC=AAPC=-19.69%,P<0.05).There was a 1.5%annual mean rise in the proportion of snail-infested areas in total snail survey areas in China from 2000 to 2020(AAPC=1.5%,P>0.05),with a turning point seen in 2004(2000-2004:APC=35.02%,P<0.05;2004-2020:APC=-0.08%,P<0.05).There were no changes in the proportion of snail-infested areas in marshland and lake regions in total snail-infested areas in China from 2000 to 2020(AAPC=0%,P>0.05),with a turning point seen in 2013(2000-2013:APC=0.16%,P<0.05;2013-2020:APC=-0.35%,P<0.05),and there was a 14.7%annual mean decline in the proportion of snail-infested areas in plain regions in total snail-infested areas in China from 2000 to 2020(AAPC=-14.7%,P<0.05),with a turning point seen in 2007(2000-2013;2013-2020:APC=-34.36%,P<0.05),while there were three turning points(2000-2005;2005-2014:APC=-5.12%,P<0.05;2014-2017:APC=19.53%,P<0.05;2017-2020)in the proportion of snail-infested areas in mountainous and hilly regions in total snail-infested areas in China from 2000 to 2020(AAPC=1%,P>0.05).Conclusion The prevalence of schistosomiasis appeared a tendency towards a decline in China from 1999 to 2020,and the integrated strategy with an emphasis on the control of infectious sources is recommended to be implemented during the stage moving towards elimination of schistosomiasis China.