2008-2017年广东省手足口病流行趋势变化特征的Joinpoint回归模型分析
|
摘要
目的了解广东省手足口病流行趋势变化特征。方法通过国家"传染病报告信息管理系统"收集2008—2017年手足口病发病资料,通过《广东统计年鉴》收集人口资料;采用Joinpoint回归模型进行分析。结果 2012年为广东省手足口病年发病率趋势变化转折点,2008—2012年间呈快速上升趋势(β_1=72.552,P=0.001),2012—2017年间呈小幅波动上升趋势,但差异无统计学意义(β_2=6.647,P=0.588);男、女性年发病率趋势变化不平衡,男性变化速度高于女性。年平均月发病率呈现"快升缓降"的"单峰"趋势变化特点,5月为峰值和转折点;1—5月间发病率呈快速上升趋势,月发病率变化百分比(APC)为138.33%(P=0.002),5—12月间呈较缓下降趋势,APC为–19.19%(P=0.002);2008、2013和2017年的月发病率趋势变化有2个转折点,其余年度均只有1个转折点。年龄组发病率呈现"高升快降低拖尾"的趋势变化特点,2～岁组和15～19岁组为转折点;从0～岁组至2～岁组,发病率呈上升趋势,年龄组APC为17.32%(P=0.001);从2～岁组至15～19岁组,发病率呈下降趋势,APC为-44.81%(P=0.000);从15～19岁组至≥85岁组,APC为–2.66%(P=0.148),呈现极低位拖尾现象。结论广东省手足口病经历了几年快速上升后,进入了小幅波动上升时期,目前仍处在高发态势;年度发病率趋势变化存在性别差异;月发病率趋势变化存在两种模式,存在显著的季节性变化;幼儿为高发人群,是重点防控对象,防控措施要更有针对性。
Objective To analyze the change in the epidemiological trends of hand, foot and mouth disease(HFMD)in Guangdong province. Methods The incidence data of HFMD in Guangdong during 2008–2017 were collected from National Notifiable Infectious Disease Reporting Information System, and population data in Guangdong during this period were collected from Guangdong Statistical Yearbook. The epidemiological trends of HFMD were analyzed by using Joinpoint regression model. Results The incidence trend of HFMD began to change in 2012. From 2008 to 2012, the incidence rate of HFMD increased sharply(β_1=72.552, P=0.001), and from 2012 to 2017, the incidence increased with slight fluctuation, the difference had no significance(β_2=6.647, P=0.588). The incidence change trend was not parallel between males and females,the change extent in males exceeded that in females. The incidence increase sharply from January to May and peaked in May,then it began to decline, the monthly annual percent change(APC) was 138.33%(P=0.002). From May to December, the incidence of HFMD declined slightly, the monthly APC was –19.19%(P=0.002). Two joinpoints were detected among the trend change of the monthly incidence rate of HFMD in 2008、2013 and 2017 years respectively and only one joinpoint was found in the other years. The age specific incidence was characterized by high level in age group from 0– to 2– years(Age group APC=17.32%, P=0.001), decrease rapidly from age group 2– years to 15–19 years(APC=-44.81%, P=0.000), and keeping at very low level from age group 15–19 years to ≥85 years(APC=-2.66%, P=0.148). Conclusion The annual incidence of HFMD in Guangdong first showed a rapid increase and then slight increase with fluctuation during 2008–2017.The trend change of annual incidence rate was significantly different between male and female. Two models were found in the trend change of monthly incidence rate and there were significant seasonal variations. Very most of the HFMD case were among young children, so they were the key object for prevention and control. Prevention and control measures should be more targeted.
Objective To analyze the change in the epidemiological trends of hand, foot and mouth disease(HFMD)in Guangdong province. Methods The incidence data of HFMD in Guangdong during 2008–2017 were collected from National Notifiable Infectious Disease Reporting Information System, and population data in Guangdong during this period were collected from Guangdong Statistical Yearbook. The epidemiological trends of HFMD were analyzed by using Joinpoint regression model. Results The incidence trend of HFMD began to change in 2012. From 2008 to 2012, the incidence rate of HFMD increased sharply(β_1=72.552, P=0.001), and from 2012 to 2017, the incidence increased with slight fluctuation, the difference had no significance(β_2=6.647, P=0.588). The incidence change trend was not parallel between males and females,the change extent in males exceeded that in females. The incidence increase sharply from January to May and peaked in May,then it began to decline, the monthly annual percent change(APC) was 138.33%(P=0.002). From May to December, the incidence of HFMD declined slightly, the monthly APC was –19.19%(P=0.002). Two joinpoints were detected among the trend change of the monthly incidence rate of HFMD in 2008、2013 and 2017 years respectively and only one joinpoint was found in the other years. The age specific incidence was characterized by high level in age group from 0– to 2– years(Age group APC=17.32%, P=0.001), decrease rapidly from age group 2– years to 15–19 years(APC=-44.81%, P=0.000), and keeping at very low level from age group 15–19 years to ≥85 years(APC=-2.66%, P=0.148). Conclusion The annual incidence of HFMD in Guangdong first showed a rapid increase and then slight increase with fluctuation during 2008–2017.The trend change of annual incidence rate was significantly different between male and female. Two models were found in the trend change of monthly incidence rate and there were significant seasonal variations. Very most of the HFMD case were among young children, so they were the key object for prevention and control. Prevention and control measures should be more targeted.
引文
[1]赵奇,朱俊萍.中国手足口病的流行状况及病原谱变化分析[J].病毒学报,2015, 31(5):554-559. DOI:10.13242/j.cnki.bing duxuebao.002776.Zhao Q, Zhu JP. Prevalence and analyses of the changing etiology of hand, foot and mouth disease in China[J]. Chin J Virol, 2015,31(5):554-559. DOI:10.13242/j.cnki.bingduxuebao.002776.
[2]冀天娇,谭小华,刘冷,等.广东省2008-2015年手足口病流行病学特征及病原学监测分析[J].病毒学报,2016, 32(6):713-720. DOI:10.13242/j.cnki.bingduxuebao.003067.Ji TJ, Tan XH, Liu L, et al. Epidemiology characteristics and pathogen surveillance of hand, foot and mouth disease in Guangdong province, China, 2008-2015[J]. Chin J Virol, 2016,32(6):713-720. DOI:10.13242/j.cnki.bingduxuebao.003067.
[3] Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates[J]. Stat Med, 2000,19(3):335-351. DOI:10.1002/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z.
[4] Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute. Joinpoint Regression Program. Version 4.5.0.1-June 12, 2017[EB/OL].(2017-06-12)[2017-07-05]. https://surveillance.cancer.gov/help/joinpoint.
[5]朱红兵,何丽娟.关于用SPSS中单样本K-S检验法进行正态分布等的一致性检验时适用条件的研究[J].首都体育学院学报,2009, 21(4):466-470. DOI:10.14036/j.cnki.cn11-4513.2009.04.019.Zhu HB, He LJ. A study on appropriate conditions in consistency test of normal distribution by single sample K-S check in SPSS[J]. J Cap Inst Phy Edu, 2009, 21(4):466-470. DOI:10.14036/j.cnki.cnl 1-4513.2009.04.019.
[6] Division of Cancer Control and Population Sciences National Cancer Institute. Joinpoint help manual 4.6.0.0[EB/OL].(2018-04-09)[2018-05-10]. https://surveillance.cancer.gov/joinpoint/Joinpoint_Help_4.6.0.0.pdf.
[7] Telli H, Saracli S. Joinpoint regression analysis and an application on Istanbul stock-exchange[J]. Alphanumeric J, 2014,2(1):44-49. DOI:10.17093/aj.56252.
[8] Pickle LW, Hao YP, Jemal A, et al. A new method of estimating United States and state-level cancer incidence counts for the current calendar year[J]. CA Cancer J Clin, 2007, 57(1):30-42. DOI:10.3322/canjclin.57.1.30.
[9] Qiu DM, Katanoda K, Marugame T, et al. A Joinpoint regression analysis of long-term trends in cancer mortality in Japan(1958-2004)[J]. Int J Cancer, 2009, 124(2):443-448.DOI:10.1002/ijc.23911.
[10]曾红梅,郑荣寿,张思维,等.1989-2008年中国恶性肿瘤死亡趋势分析[J].中华肿瘤杂志,2012, 34(7):525-531. DOI:10.3760/cma.j.issn.0253-3766.2012.07.011.Zeng HM, Zheng RS, Zhang SW, et al. Trend analysis of cancer mortality in China between 1989 and 2008[J]. Chin J Oncol,2012, 34(7):525-531. DOI:10.3760/cma.j.issn.0253-3766.2012.07.011.
[11] Lopez-Campos JL, Ruiz-Ramos M, Soriano JB. Mortality trends in chronic obstructive pulmonary disease in Europe, 1994-2010:a joinpoint regression analysis[J]. Lancet Respir Med, 2014,2(1):54-62. DOI:10.1016/S2213-2600(13)70232-7.
[12] Bandi P, Silver D, Mijanovich T, et al. Temporal trends in motor vehicle fatalities in the United States, 1968 to 2010-a joinpoint regression analysis[J]Inj Epidemiol,2015, 2:4.DOI:10.1186/s40621-015-0035-6.
[13] Chapin-Bardales J,Rosenberg ES, Sullivan PS. Trends in racial/ethnic disparities of new AIDS diagnoses in the United States, 1984-2013[J]. Ann Epidemiol, 2017, 27(5):329-334.e2. DOI:10.1016/j.annepidem.2017.04.002.
[14] Hung BT, Long NP, Hung LP, et al. Research trends in evidencebased medicine:a joinpoint regression analysis of more than 50years of publication data[J]. PLoS One, 2015,10(4):e0121054. DOI:10.1371/joumal.pone.0121054.
[15]张萌,龙遗芳,杨芬,等.2017年广东省秋季手足口病疫情高发流行特征及因素分析[J].疾病监测,2018, 33(1):37-41.DOI:10.3 784/j.issn. 1003-9961.2018.01.009.Zhang M,Long YF,Yang F,et al. Characteristics of high incidence of hand, foot and mouth disease and related factors in autumn of 2017 in Guangdong[J]. Dis Surveill, 2018, 33(1):37-41. DOI:10.3784/j.issn.1003-9961.2018.01.009.
[16]占华剑,柯昌文.全球手足口病流行现状及分子流行病学研究进展[J].华南预防医学,2011,37(5):34-38,41.Zhan HJ, Ke CW. Global epidemic situation and molecular epidemiology of hand, foot and mouth disease[J]. South China J Prev Med, 2011, 37(5):34-38,41.
[17]罗莉,邢薇佳,廖巧红,等.儿童肠道病毒71型和柯萨奇病毒A16型感染血清流行病学研究进展[J].中华预防医学杂志,2015, 49(2):184-188. DOI:10.3760/cma.j.issn.0253-9624.2015.02.018.Luo L,Xing WJ,Liao QH, et al. Research progress on seroepidemiological study of enterovirus 71 and coxsackievirus A16 infection among children[J]. Chin J Prev Med, 2015,49(2):184-188. DOI:10.3760/cma.j.issn.0253-9624.2015.02.018.
[2]冀天娇,谭小华,刘冷,等.广东省2008-2015年手足口病流行病学特征及病原学监测分析[J].病毒学报,2016, 32(6):713-720. DOI:10.13242/j.cnki.bingduxuebao.003067.Ji TJ, Tan XH, Liu L, et al. Epidemiology characteristics and pathogen surveillance of hand, foot and mouth disease in Guangdong province, China, 2008-2015[J]. Chin J Virol, 2016,32(6):713-720. DOI:10.13242/j.cnki.bingduxuebao.003067.
[3] Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates[J]. Stat Med, 2000,19(3):335-351. DOI:10.1002/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z.
[4] Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute. Joinpoint Regression Program. Version 4.5.0.1-June 12, 2017[EB/OL].(2017-06-12)[2017-07-05]. https://surveillance.cancer.gov/help/joinpoint.
[5]朱红兵,何丽娟.关于用SPSS中单样本K-S检验法进行正态分布等的一致性检验时适用条件的研究[J].首都体育学院学报,2009, 21(4):466-470. DOI:10.14036/j.cnki.cn11-4513.2009.04.019.Zhu HB, He LJ. A study on appropriate conditions in consistency test of normal distribution by single sample K-S check in SPSS[J]. J Cap Inst Phy Edu, 2009, 21(4):466-470. DOI:10.14036/j.cnki.cnl 1-4513.2009.04.019.
[6] Division of Cancer Control and Population Sciences National Cancer Institute. Joinpoint help manual 4.6.0.0[EB/OL].(2018-04-09)[2018-05-10]. https://surveillance.cancer.gov/joinpoint/Joinpoint_Help_4.6.0.0.pdf.
[7] Telli H, Saracli S. Joinpoint regression analysis and an application on Istanbul stock-exchange[J]. Alphanumeric J, 2014,2(1):44-49. DOI:10.17093/aj.56252.
[8] Pickle LW, Hao YP, Jemal A, et al. A new method of estimating United States and state-level cancer incidence counts for the current calendar year[J]. CA Cancer J Clin, 2007, 57(1):30-42. DOI:10.3322/canjclin.57.1.30.
[9] Qiu DM, Katanoda K, Marugame T, et al. A Joinpoint regression analysis of long-term trends in cancer mortality in Japan(1958-2004)[J]. Int J Cancer, 2009, 124(2):443-448.DOI:10.1002/ijc.23911.
[10]曾红梅,郑荣寿,张思维,等.1989-2008年中国恶性肿瘤死亡趋势分析[J].中华肿瘤杂志,2012, 34(7):525-531. DOI:10.3760/cma.j.issn.0253-3766.2012.07.011.Zeng HM, Zheng RS, Zhang SW, et al. Trend analysis of cancer mortality in China between 1989 and 2008[J]. Chin J Oncol,2012, 34(7):525-531. DOI:10.3760/cma.j.issn.0253-3766.2012.07.011.
[11] Lopez-Campos JL, Ruiz-Ramos M, Soriano JB. Mortality trends in chronic obstructive pulmonary disease in Europe, 1994-2010:a joinpoint regression analysis[J]. Lancet Respir Med, 2014,2(1):54-62. DOI:10.1016/S2213-2600(13)70232-7.
[12] Bandi P, Silver D, Mijanovich T, et al. Temporal trends in motor vehicle fatalities in the United States, 1968 to 2010-a joinpoint regression analysis[J]Inj Epidemiol,2015, 2:4.DOI:10.1186/s40621-015-0035-6.
[13] Chapin-Bardales J,Rosenberg ES, Sullivan PS. Trends in racial/ethnic disparities of new AIDS diagnoses in the United States, 1984-2013[J]. Ann Epidemiol, 2017, 27(5):329-334.e2. DOI:10.1016/j.annepidem.2017.04.002.
[14] Hung BT, Long NP, Hung LP, et al. Research trends in evidencebased medicine:a joinpoint regression analysis of more than 50years of publication data[J]. PLoS One, 2015,10(4):e0121054. DOI:10.1371/joumal.pone.0121054.
[15]张萌,龙遗芳,杨芬,等.2017年广东省秋季手足口病疫情高发流行特征及因素分析[J].疾病监测,2018, 33(1):37-41.DOI:10.3 784/j.issn. 1003-9961.2018.01.009.Zhang M,Long YF,Yang F,et al. Characteristics of high incidence of hand, foot and mouth disease and related factors in autumn of 2017 in Guangdong[J]. Dis Surveill, 2018, 33(1):37-41. DOI:10.3784/j.issn.1003-9961.2018.01.009.
[16]占华剑,柯昌文.全球手足口病流行现状及分子流行病学研究进展[J].华南预防医学,2011,37(5):34-38,41.Zhan HJ, Ke CW. Global epidemic situation and molecular epidemiology of hand, foot and mouth disease[J]. South China J Prev Med, 2011, 37(5):34-38,41.
[17]罗莉,邢薇佳,廖巧红,等.儿童肠道病毒71型和柯萨奇病毒A16型感染血清流行病学研究进展[J].中华预防医学杂志,2015, 49(2):184-188. DOI:10.3760/cma.j.issn.0253-9624.2015.02.018.Luo L,Xing WJ,Liao QH, et al. Research progress on seroepidemiological study of enterovirus 71 and coxsackievirus A16 infection among children[J]. Chin J Prev Med, 2015,49(2):184-188. DOI:10.3760/cma.j.issn.0253-9624.2015.02.018.