2006-2022年辽宁省大连市人间布鲁氏菌病流行特征及诊断延迟影响因素分析

Analysis on epidemiological characteristics of human brucellosis and influencing factors of delayed diagnosis in Dalian of Liaoning,2006−2022

目的 分析2006-2022年辽宁省大连市人间布鲁氏菌病(布病)疫情形势和发病特点及病例诊断延迟的影响因素,为针对性干预措施的实施提供依据。方法 从中国疾病预防控制中心传染病报告信息管理系统中获取2006-2022年大连市布病病例个案资料,对人间布病发病变化趋势、人群特征、空间分布及诊断报告情况进行描述性分析,采用logistic多因素回归分析诊断延迟的影响因素,采用ArcGIS 10.8软件进行空间自相关和聚类分析。结果 2006-2022年大连市人间布病发病整体呈逐年上升趋势,发病率平均每年上升25.89%。春夏季为发病高峰,男性高于女性(2.59∶1),发病年龄集中在45~59岁年龄组(44.23%)。病例地区分布范围逐渐扩大,2022年大连市87.26%的街道(乡镇)有病例报告。时空分布结果显示,高–高聚集地区始终集中在瓦房店市。诊断延迟率为60.68%,多因素分析结果显示,就诊医院类型[比值比(OR)=0.68,95%置信区间(CI):0.56~0.83,P<0.05]和病例报告年份(OR=1.34,95%CI:1.11~1.62,P<0.05)与诊断延迟有关。结论 辽宁省大连市人间布病发病率呈逐年快速上升趋势,诊断延迟率较高。应及时采取针对性干预措施,加强宣传教育,提升人群就诊意识和基层医务人员诊断水平,降低因延迟诊断导致的布病慢性化。

Objective To analyze the epidemiological characteristics of human brucellosis in Dalian,identify key populations and key areas and provide evidence for the development of targeted intervention measures.Methods The incidence data of human brucellosis in Dalian during 2006–2008 were collected from the National Notifiable Infectious Disease Reporting System of Chinese Center for Disease Control and Prevention.Descriptive epidemiological methods were used to analyze the incidence trend,demographic characteristics,spatial distribution and diagnosis or reporting of human brucellosis.The factors causing diagnosis delay were analyzed by using logistic regression model,and the spatial autocorrelation and clustering analysis were performed with ArcGIS 10.8.Results From 2006 to 2022,the incidence of human brucellosis increased in Dalian,with an average annual increase of 25.89%.The incidence peak occurred in spring and summer.More cases occurred in men than in women(2.59:1).The cases were mainly people aged 45–59 years(44.23%).The distribution of cases gradually expanded,and 87.26%of streets(townships)had cases reported.Local spatial auto-correlation analysis showed that the highly clustering areas were always in Wafangdian.The diagnosis delay rate was 60.68%.Multivariate logistic regression analysis showed that the type of hospital[odds ratio(OR)=0.68,95%confidence interval(CI):0.56–0.83,P<0.05]and the year of case reporting(OR=1.34,95%CI:1.11–1.62,P<0.05)were associated with the delayed diagnosis.Conclusion The incidence of human brucellosishowed an obvious upward trend in Dalian,and the diagnosis delay rate was high.It is necessary to take targeted intervention measures timely,strengthen health education to improve the awareness of medical care seeking of the patients and improve the diagnosis level of primary medical staff to reduce the prevalence of chronic brucellosis due to delayed diagnosis.