云南省2004-2021年梅毒流行特征和发病趋势

Epidemiological characteristics and incidence trend of syphilis in Yunnan Province from 2004 to 2021

目的了解云南省梅毒流行特征和发病趋势,为制定云南省梅毒防控策略提供支持依据。方法通过中国疾病预防控制信息系统传染病监测系统收集云南省2004-2021年报告的梅毒疫情数据进行描述性分析,应用Joinpoint回归模型进行时间趋势分析,计算年度变化百分比(APC)和平均年度变化百分比(AAPC)。结果云南省梅毒报告发病率由2004年的1.32/10万上升至2021年的36.89/10万,AAPC为21.78%(Z=23.39,P<0.001),呈先升后平稳趋势(2004-2008年APC=48.96%,P<0.001,2008-2015年APC=26.68%,P<0.001,2015-2021年APC=1.71%,P>0.05)。其中一期与二期梅毒整体呈上升趋势,AAPC为4.93%(Z=2.38,P<0.05),呈先升后降,平稳过渡后再上升趋势(2004-2012年APC=20.54%,P<0.001,2012-2016年APC=-31.69%,P<0.001,2016-2019年APC=8.20%,P>0.05,2019-2021年APC=35.75%,P<0.01);隐性梅毒与梅毒变化趋势相同。女性梅毒报告发病率高于男性(χ^(2)=3179.88,P<0.001),男性梅毒报告发病率和女性梅毒报告发病率总体均呈上升趋势;各年龄组梅毒变化整体呈上升趋势;职业分布以农民为主(66.47%),AAPC前三位的职业分别为学生(AAPC=30.03%)、农民(AAPC=28.27%)、家务及待业(AAPC=22.62%)。全省16个州(市)AAPC前五位的为昭通市(AAPC=33.85%)、怒江州(AAPC=32.60%)、红河州(AAPC=27.77%)、文山州(AAPC=27.53%)和大理州(AAPC=24.34%)。结论2004-2015年,云南省梅毒报告发病率呈快速上升,2015-2021年趋于平稳,其中一期与二期梅毒2004年呈快速上升,2012年出现下降趋势,2019年起呈现一定程度波动且有上升的趋势,提示云南省梅毒防控形势依然严峻,应加强重点人群预防梅毒感染的宣传教育、行为干预、动员检测和规范治疗。

Objective To understand the epidemiological characteristics and incidence trend of syphilis,and to provide evidence for the development of syphilis control and prevention strategies in Yunnan Province.Methods Syphilis epidemics data was collected through China Disease Prevention and Control Information System from 2004 to 2021 in Yunnan for descriptive analysis.Time trend analysis was performed to calculate annual percentage change(APC)and average annual percentage change(AAPC)by Joinpoint regression model.Results The total reported incidence of syphilis in Yunnan Province increased from 1.32/106 in 2004 to 36.89/106 in 2021,and the AAPC was 21.78%(Z=23.39,P<0.001),showing a rising trend at first and then stability(2004-2008 APC=48.96%,P<0.001;2008-2015 APC=26.68%,P<0.001;2015-2021 APC=1.71%,P>0.05).The overall trend of stage I and II syphilis was increasing,with an AAPC of 4.93%(Z=2.38,P<0.05),which showed a trend of increasing at the beginning and then decreasing,next followed by a plateau and then a rise again(2004-2012 APC=20.54%,P<0.001,2012-2016 APC=-31.69%,P<0.001;2016-2019 APC=8.20%,P>0.05;2019-2021 APC=35.75%,P<0.01).The trend of occult syphilis was the same as that of syphilis.The reported incidence of syphilis was higher in women than in men(χ2=3179.88,P<0.001),and the reported incidence of syphilis in both men and women showed an overall increasing trend.The changes of syphilis incidence in all age groups were showing a trend of increasing.The predominant occupations was farmers(66.47%);and as per AAPC,the top three occupations were students(AAPC=30.03%),farmers(AAPC=28.27%),housework and unemployment(AAPC=22.62%),respectively.The top five AAPC in 16 Prefecture(Municipality)were Zhaotong(AAPC=33.85%),Nujiang(AAPC=32.60%),Honghe(AAPC=27.77%),Wenshan(AAPC=27.53%)and Dali(AAPC=24.34%),respectively.Conclusions Syphilis in Yunnan Province increased rapidly from 2004 to 2015,and stabilized from 2015 to 2021.Stage I and II syphilis increased rapidly in 2004,decreased gradually in 2012,and fluctuated and increased to a certain extent since 2019.It indicates that the situation for syphilis in Yunnan Province is still serious.It is necessary to strengthen the propaganda education,behavior intervention,mobilization test,and standardized treatment for prevention of syphilis in the targeted population.