2005—2021年湖北省肾综合征出血热流行特征及空间异质性分析

Epidemic characteristics and spatial heterogeneity of hemorrhagic fever with renal syndrome in Hubei Province from 2005 to 2021,China

目的总结2005—2021年湖北省肾综合征出血热(HFRS)流行特征及高发区域变化趋势,为HFRS防控提供科学依据。方法自中国疾病预防控制信息系统收集2005—2021年湖北省HFRS病例个案信息和人口资料,描述HFRS病例的时间、地区和人群分布特征,采用中位数、率和构成比进行统计描述。joinpoint回归和spearman等级相关用于分析发病率或构成比随年份变化趋势。全局自相关和热点分析用于空间聚集性分析。二分类logistic回归用于分析HFRS死亡的危险因素。结果2005—2021年累计报告5790例,死亡117例,年平均发病率0.57/10万,病死率2.02%。湖北省HFRS发病率整体呈上升趋势(AAPC=4.05%,95%CI:1.32%~6.78%)。病死率随年份整体呈下降趋势(r s=-0.72,P=0.002)。HFRS发病呈双峰型特点,5—7月为春夏季高峰,11月至次年1月为秋冬季高峰;秋冬季高峰略高于春夏季高峰。男性发病率高于女性(RR=2.96,95%CI:2.79~3.14)。发病率前3位年龄组为60~64岁(747例,1.55/10万)、65~69岁(515例,1.39/10万)和55~59岁(762例,1.23/10万);14岁及以下人群发病率、占比随年份无明显趋势变化(95%CI:-0.03%~0.31%;95%CI:-8.79%~1.50%);60岁及以上年龄组发病率、占比随年份呈上升趋势(AAPC发病率=10.52%,95%CI发病率:4.38%~16.66%;AAPC占比=175.98%,95%CI占比:143.20%~208.75%)。HFRS发病均具有明显空间聚集性(P<0.05);湖北省HFRS热点区域由2005—2007年鄂北部(襄阳市、随州市、荆门市)等地转移至2020—2021年鄂南部(潜江市、仙桃市、天门市、荆州市)。年龄大(OR=1.02,95%CI:1.01~1.04)、2005—2008年较2017—2021年(OR=0.98,95%CI:0.97~0.99)HFRS死亡风险高。结论近年来湖北省HFRS疫情持续高发。以潜江市等长江中下游地区高发,60岁以上人群逐渐成为高发人群,应制定针对性措施以遏制HFRS上升趋势。

This study was aimed at summarizing the epidemiological characteristics and spatial-temporal changes of hemorrhagic fever with renal syndrome(HFRS)in Hubei Province,China from 2005 to 2021,to provide scientific evidence for HFRS prevention and control.Data on individual HFRS cases and population information in Hubei Province from 2005 to 2021 were collected from the China Disease Prevention and Control Information System.The temporal,spatial,and demographic distribution characteristics of HFRS cases are described,and statistical methods such as medians,rates,and composition ratios were used for analysis.Joinpoint regression and Spearman’s rank correlation were used to analyze the temporal trends in incidence rates or composition ratios.Global autocorrelation and hotspot analysis were conducted for spatial clustering analysis.Binary logistic regression was performed to analyze risk factors for HFRS mortality.A total of 5790 HFRS cases were reported from 2005 to 2021,including 117 deaths.The average annual incidence rate was 0.57 per 100000 population,and the case fatality rate was 2.02%.The overall incidence rate of HFRS in Hubei Province showed an increasing trend(AAPC=4.05%,95%CI:1.32%-6.78%),whereas the case fatality rate showed a decreasing trend over the years(r s=-0.72,P=0.002).HFRS exhibited a bimodal pattern,with peaks in the spring/summer months(May to July)and in the autumn/winter months(November to January of the following year).The incidence rate during the autumn/winter peak was slightly higher than that in the spring/summer peak.The incidence rate in males was higher than in females(RR=2.96,95%CI:2.79-3.14).The three age groups with the highest incidence rates were 60-64 years(747 cases,1.55 per 100000),65-69 years(515 cases,1.39 per 100000),and 55-59 years(762 cases,1.23 per 100000).The incidence rate(2005:0.05 per 100000;2021:0.08 per 100000)and proportion(2005:2.69%;2021:1.94%)of HFRS cases in individuals 14 years or younger showed no significant trend over the years(AAPC=0.14%,95%CI:-0.03%-0.31%;AAPC=-3.64%,95%CI:-8.79%-1.50%).The incidence rate(2005:0.58 per 100000;2021:1.59 per 100000)and proportion(2005:14.80%;2021:44.31%)in the age group of 60 years or above showed an increasing trend over the years(AAPC=10.52%,95%CI:4.38%-16.66%;AAPC=175.98%,95%CI:143.20%-208.75%).HFRS cases exhibited significant spatial clustering(P<0.05).The hotspots of HFRS in Hubei Province shifted from the northern region(Xiangyang,Suizhou,Jingmen)in 2005-2007 to the southern region(Qianjiang,Xiantao,Tianmen,Jingzhou)in 2020-2021.Older age(OR=1.02,95%CI:1.01-1.04)and the period of 2005-2008 versus 2017-2021(OR=0.98,95%CI:0.97-0.99)were associated with relatively higher risk of HFRS mortality.In recent years,the HFRS epidemic in Hubei Province has continued to escalate,and areas such as Qianjiang City and other ares in the middle and lower reaches of the Yangtze River have experienced high incidence rates.The population 60 years of age or above is gradually becoming more susceptible to the disease.Targeted measures should be implemented to curb the rising trend of HFRS.