2008-2023年云南省甲型肝炎流行病学特征及时空聚集性分析  

Epidemiological characteristics and spatiotemporal clustering of hepatitis A in Yunnan,2008-2023

作　　者：李宁 贾豫晨 刘榕 邬志薇[1] 王紫鉴 何继波[1] Li Ning;Jia Yuchen;Liu Rong;Wu Zhiwei;Wang Zijian;He Jibo(Yunnan Center for Disease Control and Prevention,Kunming 650000,Yunnan,China;Kunming Medical University,Kunming 650000,Yunnan,China)

机构地区：[1]云南省疾病预防控制中心,云南昆明650000 [2]昆明医科大学,云南昆明650000

出　　处：《疾病监测》2025年第2期189-195,共7页Disease Surveillance

摘　　要：目的分析2008—2023年云南省甲型肝炎(甲肝)流行病学特征和时空聚集性分布特征,为甲肝防控提供理论依据。方法描述甲肝病例的三间分布特征,发病率和年龄趋势使用线性回归趋势检验。使用R4.3.3软件进行全局空间自相关分析和时空扫描分析,采用ArcGIS10.8.2软件进行局部空间自相关分析。结果2008—2023年云南省累计报告甲肝病例27176例,年均报告病例1699例,年均报告发病率为3.62/10万,呈下降趋势(系数b=-0.45,P<0.001)。年龄中位数为28岁,呈上升趋势(决定系数R^(2)=0.89,P<0.01)。2008—2023年,0~、10~、20~和30~岁年龄组人群报告发病率均呈下降趋势(P<0.01)。全局空间自相关分析结果显示,除2011年,2008—2023年均存在全局空间相关性(P<0.05)。局部空间自相关和时空扫描分析结果显示,甲肝高发地区集中在云南省东南部和南部地区,即由丘北县向西南延伸至孟连傣族拉祜族佤族自治县一带,此片区域既是高-高聚集区域,又是一级聚集区(20个县、区)。从2017年开始,普洱市大部分县(区)均为高风险地区。从2020年开始,曲靖市部分县(区)连续多年成为高风险地区。此外,宁蒗彝族自治县作为次级聚集区,实际观测病例数为535例,预期病例数为135例,是聚集性相对危险度(ARR)最高的地区,表明该县具有较高的聚集性发病风险。结论2008—2023年云南省甲肝发病率呈下降趋势,年龄发病高峰后移。高发职业人群由原来的学生和散居儿童转变为农民、离退人员和家务及待业人员。在空间聚集性方面,重点关注由丘北县向西南延伸至孟连傣族拉祜族佤族自治县范围内的高风险聚集县(区),以及已经再次成为高发地区的普洱市部分县(区)和可能成为持续高发地区的曲靖市部分县(区),探索位于云南省西北部的宁蒗彝族自治县ARR值异常升高的原因,为采取针对性防控措施提供依据。Objective To analyze the epidemiological characteristics and spatiotemporal clustering of hepatitis A in Yunnan province from 2008 to 2023 and provide a theoretical basis for the prevention and control of hepatitis A.Methods The distributions of hepatitis A cases in Yunnan were described.Linear regression trend test was used for incidence rate and age specific incidence.Global spatial autocorrelation analysis and spatiotemporal scan analysis was conducted by using software R4.3.3,and local spatial autocorrelation analysis was conducted by using ArcGIS10.8.2.Results From 2008 to 2023,a total of 27176 hepatitis A cases were reported in Yunnan with an annual average of 1699 cases.The annual average incidence rate was 3.62/100000,showing a downward trend(coefficient:b=-0.45,P<0.001).The median age of the cases was 28 years,showing an upward trend(multiple R-squared:R^(2)=0.89,P<0.01).From 2008 to 2023,the reported incidence rates of hepatitis A in age groups 0-,10-,20-,and 30-years all showed downward trends(P<0.01).The results of global spatial autocorrelation analysis showed that there was global spatial correlation from 2008 to 2023 except 2011(P<0.05).The results of local spatial autocorrelation and spatiotemporal scan analysis showed that the areas with high incidence of hepatitis A were mainly in southeastern and southern Yunnan,i.e.a belt from Qiubei to Menglian in the southwest(a high-high clustering area and a class I clustering area covering 20 districts and counties).Since 2017,most counties(districts)in Pu'er had been the highrisk areas.Since 2020,some counties(districts)in Qujing had become high-risk areas for consecutive years.In addition,as a class II clustering area,Ninglang had 535 cases being actually observed and 135 cases being predicted.It is the area with the highest clustering relative risk,indicating that this county had a relatively high risk for case clustering.Conclusion From 2008 to 2023,the incidence rate of hepatitis A in Yunnan showed a downward trend,and the age specific incidence peak

关 键 词：甲型肝炎 空间聚集性分析 不规则时空扫描 流行病学特征 

分 类 号：R211[医药卫生—中医学] R512.61