山东省居民急性心肌梗死发病流行特征及空间聚集性分析

Epidemiological characteristics and spatial aggregation of acute myocardial infarction in Shandong Province

目的了解山东省居民急性心肌梗死(AMI)发病特征和流行趋势,为制定防控策略提供科学依据。方法资料源自2012-2021年山东省慢性病监测信息管理系统上报的AMI发病数据。以粗发病率和标化发病率为指标描述AMI发病水平,采用Joinpoint回归分析发病率和发病年龄随年份的变化趋势。应用率的差别分解法评估人口老龄化对AMI发病率上升的贡献度。采用ArcGIS 10.8软件对山东省各区(县)发病率进行地图可视化展示,采用DeoDa 1.12软件进行全局和局部空间自相关分析。结果2012-2021年,山东省19个省级监测点共报告AMI发病198233人次,男性占53.13%,≥45岁人群占97.12%。报告粗发病率从2012年的90.12/10万上升至2021年的176.54/10万,年均上升7.01%(Z=7.35,P<0.001),标化发病率无明显上升趋势(Z=1.64,P=0.140),但男性标化发病率呈上升趋势(Z=2.76,P=0.028)。2014年前男性报告粗发病率与女性持平,2014年后男性报告粗发病率持续高于女性,各年份男性标化发病率均高于女性;各年份农村居民粗发病率和标化发病率均高于城市居民。AMI中位发病年龄从2012年的71.6岁上升至2021年的73.5岁,各年份男性中位发病年龄低于女性,多数年份城市居民中位发病年龄低于农村居民。男性AMI发病呈一定的年轻化趋势。经季节性分解,AMI发病高峰为1月,发病低谷为9月。人口老龄化对AMI粗发病率上升的贡献占比从2013年的8.63%上升至2021年的52.58%。全局空间自相关分析显示,AMI发病呈明显的空间聚集性分布;局部空间自相关分析发现,高发区(县)主要集中在山东省西北地区的聊城市、德州市以及西南地区菏泽市。结论山东省居民AMI发病率呈上升趋势,且具有空间聚集性和季节聚集性,≥45岁、男性和农村居民是发病高危人群,男性发病呈一定的年轻化趋势。应针对高发季节、高危人群和山东省西北地区高发聚集区域采取重点防控措施。

Objective To understand the characteristics and trends of acute myocardial infarction(AMI)in Shandong Province and to provide evidence for formulating prevention and control strategies.Methods Data were derived from the AMI incidence reports of Shandong Province's Chronic Disease Surveillance Information Management System in 2012-2021.The crude and standardized incidence rates were used as indicators to describe the incidence level of AMI.Joinpoint regression analysis was used to analyze the trends in the incidence and age of onset over the years.The contribution of population aging to the increase in AMI incidence was assessed using the rate difference decomposition method.The incidence of AMI in each district(county)in Shandong Province was visualized using ArcGIS 10.8 software,and global and local spatial autocorrelation analysis was performed using DeoDa 1.12 software.Results From 2012 to 2021,198233 cases of AMI were reported from 19 provincial monitoring sites in Shandong Province,of which 53.13%were males and 97.12%were≥45 years old.The reported crude incidence increased from 90.12 per 100000 in 2012 to 176.54 per 100000 in 2021,with an average annual increase of 7.01%(Z=7.35,P<0.001).There was no significant upward trend in standardized incidence(Z=1.64,P=0.140),but the standardized incidence of male residents showed an increasing trend(Z=2.76,P=0.028).Before 2014,the reported crude incidence of males was similar to that of females,but after 2014,the reported crude incidence of males was continuously higher than that of females.However,males'standardized incidence was higher than females in all years.Both crude and standardized incidence rates were higher in rural residents than in urban areas.The median onset of AMI increased from 71.6 years old in 2012 to 73.5 years old in 2021.The median age of onset in males was lower than that in females in all years,and in most years,the median age of onset in urban residents was lower than that in rural residents.The incidence of AMI in males showed a trend in younger age groups.According to the seasonal decomposition,the incidence peak of AMI was in January,and the trough was in September.The contribution of aging population to the increase in crude incidence of AMI increased from 8.63%in 2013 to 52.58%in 2021.The global spatial autocorrelation analysis showed that the incidence of AMI presented an obvious spatial clustering distribution.Local spatial autocorrelation analysis found that the high-incidence areas(counties)were mainly concentrated in Liaocheng City and Dezhou City in the northwest region of Shandong Province and Heze City in the southwest.Conclusions The incidence of AMI among residents in Shandong Province was rising,with spatial clustering and seasonal clustering characteristics.People aged 45 years and older,male residents,and rural residents were at high risk of developing AMI.There was a certain trend of younger age at onset among men.Targeted prevention and control measures should be taken for high-incidence seasons,high-risk groups,and high-incidence clustering areas in northwestern Shandong Province.