2009—2019年青海省手足口病的时空聚集性分析

Spatial-temporal clustering analysis of hand,foot and mouth disease in Qinghai Province from 2009 to 2019

目的 描述2009—2019年青海省手足口病流行特征,探究社会经济因素对发病的影响及其空间异质性。方法 获取2009—2019年青海省手足口病监测数据及人口数据,收集各区县的地区生产总值、出生人口、普通中小学人数、每千人床位数、每千人医生数、人口密度、境内公路里程、民用汽车数量、医疗支出和居民储蓄余额数据,采用秩相关系数描述年发病率与变量间的相关程度,采用地理加权回归探索变量间关系及异质性。结果 2009—2019年青海省报告手足口病24 293例,其中5岁及以下21 297例,重症7例。除境内公路里程外,地区生产总值、出生人口等10个因素均与手足口病年发病率相关。经共线性诊断后,有9个因素纳入地理加权回归模型,每千人床位数和每千人医生数影响最大,局部回归系数为22.480和21.119。结论 青海省社会经济因素对手足口病发病有影响,每千人床位数和每千人医生数影响程度最大且为正向影响。普通中学人数、每千人医生数、人口密度和境内公路里程对手足口病发病的影响具有空间异质性。经济水平的总体提高可减少发病,应根据各区县实际情况进行防控政策的制定。

Objective To describe the epidemic characteristics of hand,foot and mouth disease(HFMD) from 2009 to 2019,and to explore the impact of socio-economic factors on the incidence and its spatial heterogeneity in Qinghai Province.Methods Reported cases and demographic data of HFMD in Qinghai Province together with the regional GDP,birth population,the number of middle school students,the number of primary school students,the number of beds and doctors per thousand,population density,domestic highway mileage,number of civilian vehicles,medical expenses and resident savings balance in each county from 2009 to 2019 were obtained.The rank correlation coefficient was used to describe the degree of correlation between the incidence rate and the variables.The geographically weighted regression method(GWR) was used to explore the relationship between variables and their heterogeneity.Results From 2009 to 2019,a total of 24 293 cases of HFMD were reported in Qinghai,of which 21 297 cases were aged 5 and younger and 7cases were severe.All the 10 factors were related to the annual incidence rate except for the domestic highway mileage.After the collinearity diagnosis,nine factors were included in the GWR model.The results showed that the number of beds per thousand and the number of doctors per thousand had the greatest impact,the local regression coefficients were 22.480 and 21.119,respectively.Conclusions Socio-economic factors impacted the incidence of HFMD,the number of beds and doctors per thousand people had significant and positive impact.The impacts of the number of middle school students,doctors per thousand people,population density and domestic highway mileage on the incidence were spatially variability.In addition to improving the overall economic level to reduce the incidence of disease,prevention and control policies should be formulated according to the actual situation of each county and district.