2006-2019年山东省临沂市恙虫病流行趋势及其社会经济影响因素

Epidemiological trend and socioeconomic influencing factors of scrub typhus in Linyi City, Shandong Province, from 2006 to 2019

    摘要
  • 摘要:
    目的 分析2006-2019年山东省临沂市恙虫病的流行趋势变化, 并研究其社会经济影响因素。
    方法 2006-2019年临沂市恙虫病病例数据来源于山东省传染病报告信息管理系统, 人口和社会经济数据来自临沂市统计局发布的《统计年鉴》。采用描述性分析、Joinpoint回归模型分析恙虫病的流行特征及发病率的变化趋势, 并应用主成分分析对社会经济变量进行降维, 构建贝叶斯时空模型分析其与恙虫病发病风险的关联。
    结果 2006-2019年临沂市共报告恙虫病病例2 430例, 无死亡病例, 年均发病率为1.675/10万；发病率排前三位的县(区)是蒙阴县(3.998/10万)、郯城县(3.754/10万)和兰陵县(2.828/10万)。临沂市恙虫病的发病率在2016年出现拐点, 2006-2016年间发病率呈现上升趋势, 年度变化百分比(APC)为23.96%(P＜0.001), 2016-2019年趋于稳定(APC=-18.63%, P=0.284)；该病呈季节性升高, 9~11月高发。主成分分析提取出三个主成分, 主成分(PC)1主要与绿化指标和城市建设相关、PC2与医疗卫生资源相关、PC3与用水和燃气普及率相关。PC1(RR=1.226；95%CI：1.024~1.432)和PC2(RR=1.422；95%CI：1.137~1.733)与恙虫病发病风险呈正相关, 而PC3(RR=0.760；95%CI：0.640~0.900)与发病风险呈负相关。
    结论 临沂市恙虫病的发病率在2016年前呈现上升趋势, 但2016年后趋于稳定, 秋冬季高发。恙虫病的发病风险受社会经济多种因素的影响, 基本卫生条件改善如清洁水源、燃气普及可降低发病风险, 但绿化面积扩大、城市建设可能会增加恙虫病发病风险。

     

    Abstract:
    OBJECTIVE To analyze the epidemiological trends of scrub typhus in Linyi City, Shandong Province, from 2006 to 2019, and investigate its socioeconomic influencing factors.
    METHODS The data on scrub typhus cases in Linyi City from 2006 to 2019 were sourced from the Infectious Disease Reporting Information Management System of the Shandong Provincial, while demographic and socioeconomic data were obtained from the "Statistical Yearbook" published by the Linyi City Bureau of Statistics. Descriptive analysis and Joinpoint regression model were employed to analyze the epidemiological characteristics and trends in the incidence rate of scrub typhus. Principal component analysis was applied to reduce the dimensionality of socioeconomic variables, and a Bayesian spatiotemporal model was constructed to analyze their association with the incidence risk of scrub typhus.
    RESULTS From 2006 to 2019, a total of 2 430 cases of scrub typhus were reported in Linyi City, with no deaths reported. The annual average incidence rate was 1.675/100 000. The top three counties (districts) with the highest incidence rates were Mengyin County (3.998/100 000), Tancheng County (3.754/100 000) and Lanling County (2.828/100 000). The incidence rate of scrub typhus in Linyi City showed an inflection point in 2016. From 2006 to 2016, the incidence rate showed an upward trend, with an annual percentage change (APC) of 23.96% (P < 0.001). From 2016 to 2019, the rate stabilized (APC=-18.63%, P=0.284). The disease showed seasonal increases, with high incidence from Sep. to Nov. Principal component analysis extracted three principal components (PCs). PC1 was mainly related to greening indicators and urban construction, PC2 to medical and health resources and PC3 to water and gas access rates. PC1 (RR=1.226.95%CI: 1.024-1.432) and PC2 (RR=1.422.95%CI: 1.137-1.733) were positively correlated with the incidence risk of scrub typhus, while PC3 (RR=0.760.95%CI: 0.640-0.900) was negatively correlated with the incidence risk.
    CONCLUSIONS The incidence rate of scrub typhus in Linyi City shows an upward trend before 2016, but stabilizes after 2016, with a high incidence during autumn and winter. The incidence risk of scrub typhus is influenced by various socioeconomic factors. Improvements in basic sanitation conditions, such as access to clean water sources and the widespread use of gas, can reduce the incidence risk, while the expansion of green spaces and urban construction may increase the incidence risk of scrub typhus.

     

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