| CHAPTER ? ANALYSIS ON EPIDEMIOLOGICAL CHARACTERISTICS OF DEATH CAUSES SURVEILLANCE FOR NOTIFIABLE INFECTIOUS DISEASES IN 7 DISEASE SURVEILLANCE SITES IN GUANGXI FROM 2008 TO 2015[Objective] To reorganize and carry out statistical analysis of death causes surveillance data for notifiable infectious diseases in 7 disease surveillance sites in Guangxi over the past 2008-2015,to understand the death situation,trend of development of notifiable infectious diseases and rank order of causes of death in 7 disease surveillance sites in Guangxi,so as to provide scientific basis and clues for the formulation of strategies for prevention and control of infectious diseases by administrative decision-making departments in future.[Methods] The study was performed mainly based on mathematical statistics analysis.Surveillance data were collected and reorganized concerning the death causes of notifiable infectious diseases in 7 disease surveillance sites(Xingning District,Binyang County,Liubei District,Xiufeng District,Hepu County,Lingyun County,and Luocheng County)in Guangxi from 2008 to 2015.The underlying causes of death were coded according to International Classification of Diseases-10(ICD-10).Furthermore,39 types of notifiable infectious diseases(Class A,B and C)were classified on the basis of the Law of the People's Republic of China on the Prevention and Treatment of Infectious Diseases.Microsoft Excel 2013 and SPSS 16.0 software were used to calculate the mortality of infectious diseases,standardized mortality,rank order of causes of death,and the ratio of components to the different levels of gender,age as well as urban and rural areas.Chi-square and chi-square test for a contingency table were used for two or more mortality rates.A tendency chi-square test was applied for the mortality of time series.Besides,the index trend and test results were comprehensively analyzed and discussed.[Results](1)The average mortality rate of notifiable infectious diseases in 7 disease surveillance sites was 9.58/10 million in Guangxi in the past 2008-2015.The standardized mortality rate was 7.93/10 million.In the past 8 years,the mortality rate of infectious diseases was increased first and then decreased,and showed the trend of overall decline,reaching the highest point in 2009(14.03/10 million),and the lowest in 2015(6.46/10 million).(2)In the past 8 years,the first 5 cases regarding the rank order of causes of death for infectious diseases in Guangxi residents were: pulmonary tuberculosis(4.24/10 million),viral hepatitis(3.53/10 million),AIDS(0.80/10 million),rabies(0.30/10 million),and influenza(0.23/10 million).Pulmonary tuberculosis,viral hepatitis and AIDS accounted for 89.38% of total deaths,acting as the main death causes of infectious diseases among residents.(3)On the gender levels,the average mortality rate of male infectious diseases was 14.13/10 million in the past 8 years,and the standardized rate was 12.32/10 million.The average mortality rate of female infectious diseases was 4.61/10 million,and the standardized rate was 3.58/10 million.The mortality rate of infectious diseases of males was significantly higher than that of females(?2=1012.941,P <0.001);The mortality rate of infectious diseases of males was significantly higher than that of females each year,with the numerical difference of about 3 times.In the past 8 years,mortality of male and female infectious diseases both showed the total trend of increased first and then decreased,indicating an overall decline.Except for influenza,hand-foot-and-mouth disease and infectious diarrhea,the mortality rate of other diseases of males was remarkably higher than that of females.(4)On the level of urban and rural areas,the average mortality rate of infectious diseases of urban and rural residents was 5.39/10 million and 11.50/10 million in Guangxi in the past 8 years,respectively.The average mortality rate in urban areas was significantly lower than that in rural areas(?2=700.385,P <0.001).The mortality of infectious diseases among urban residents was significantly lower than that among rural residents in 2008-2013.However,there was no significant difference in the mortality rate of infectious diseases between urban and rural areas in 2014-2015.The mortality rate of AIDS in urban areas(1.04/10 million)was higher than that in rural areas(0.68/10 million).Except for AIDS and infectious diarrhea,the mortality of other diseases in urban areas was all significantly lower than that in rural areas.The numerical difference was about more than 2 times.The mortality rate of infectious diseases in rural areas displayed the trend of increased first and then decreased,with an overall trend of decreasing year by year.The mortality rate of infectious diseases in urban areas fluctuated repeatedly around the same numerical level.(5)On the age level,the average mortality rate of infectious diseases within the past 8 years was 9.50/10 million in the 0 year old group,3.78/10 million in 1-4 years old group,0.33/10 million in 5-14 years old group,3.22/10 million in 15-44 years old group,12.22/10 million in 45-64 years group,and 51.15/10 million in ?65 years old group.The difference of total mortality and the mortality rate per year in each age group were both statistically significant(P <0.001).The total mortality rate of infectious diseases presented on the trend of first descending and then rising with age.At the age of 0,there was a first small peak.The lowest point was reached at the age of 5-14.After that,it was elevated with age and increased sharply at ?65 years old.In view of the above diseases in specifics,there were three different trends in mortality rate of infectious diseases with age.Except for the 5-14 years old group,the mortality rate of infectious diseases of different age groups increased first and then decreased in general,and presented on the trend of declining year by year.It was consistent with the variation tendency of mortality rate of total population.Hand-foot-and-mouth disease was the leading cause of death for residents in the 0 year old group(32.35%,3.07/10 million)and the 1-4 years old group(73.21%,2.76/10 million).Rabies was the primary cause of death for residents in the 5-14 years old group(50%,0.16/10 million).Viral hepatitis was the top death causes for residents in the 15-44 years old group(38.86%,1.25/10 million) and the 45-64 years old group(47.03%,5.75/10 million).Pulmonary tuberculosis was the first cause of death for residents in ?65 years old group(55.82%,25.55/10 million).The composition of AIDS reached the highest level in the 15-44 years old group(22.54%),and then decreased with the increase of age group.(6)On the level of the year of different diseases types,except in 2009 and 2010,the first three cases of the rank order of causes of death for infectious diseases were pulmonary tuberculosis,viral hepatitis and AIDS in observed residents during the 8 years.The sum of composition ratio of the three major diseases was more than 86% per year,but the rank order of different years changed to some extent.The general trend of death rate of tuberculosis and viral hepatitis in different years all increased first and then decreased in general,reaching the peak in 2009-2010.Then it was decreased gradually or decreased with fluctuation year after year.The mortality rate of influenza reached its peak in 2009(0.87/10 million,6.22%),and was stable at a low level fluctuations in the rest of the year.The mortality rate of hand-foot-and-mouth disease decreased after reaching the peak in 2010(0.90/10 million,6.60%),and rouse again two times.The mortality rate of AIDS was on the trend of an initial slow rise and then decline with fluctuation,reaching its peak in 2012(1.13/10 million,13.64%).(7)On the level of monitoring site,pulmonary tuberculosis was the leading cause of death among residents in Hepu county(61.14%,5.92/10 million)and Xingning District(56.98%,4.53/10 million);Viral hepatitis was the primary cause of death in Binyang county(45.06%,5.91/10 million),Lingyun county(49.59%,4.00/10 million),Liubei District(36.08%,1.01%),Luocheng county(42.09%,6.18/10 million)and Xiufeng District(40.54%,2.39/10 million).The mortality rate of rabies and influenza was relatively high in Luocheng County;The mortality rate of infectious diseases among residents in Luocheng County(14.69/10 million)and Binyang County(13.13/10 million)was significantly higher than that in other counties.The mortality rate of infectious disease of AIDS was relatively higher in Binyang County,Liubei District,Xingning District and Xiufeng District.(8)On the level of nation,there was no significant difference of the annual mortality rate of infectious diseases and the average mortality rate of infectious diseases among major nations during the past 8 years;Pulmonary tuberculosis was the primary cause of death in the Han nationality(47.29%,4.56/10 million).Viral hepatitis was the primary cause of death of inhabitants of the Zhuang nationality(43.18%,4.14/10 million),Yao nationality and Mulam ethnic minority.The death level of influenza was evidently higher among the residents in the Yao nationality(11.76%,0.80/10 million)and the Mulam ethnic minority(15.15%,1.77/10)than that in the Han and Zhuang nationalities.The death level of pulmonary tuberculosis in Han nationality was obviously higher than that in other nationalities.The death level of infectious diarrhea in Han nationality was significantly lower than that in other nationalities.[Conclusions](1)The epidemic trend of infectious diseases in 7 disease surveillance sites in Guangxi showed the main regularity in the past 2008-2015 years.To be specific,there was a similar trend in the main nations(Han and Zhuang nationality),the main age group(15 years and above),the major diseases(Pulmonary tuberculosis and viral hepatitis)and the main proportion of urban and rural areas(rural areas).It simultaneously shows the trend of mortality change of male,female and total population.More precisely,the mortality rate of infectious diseases increases first over time and decreases in a fluctuation way after reaching the peak in 2009-2010.It indicates that the prevention and control of infectious diseases is effective in the past.Besides,the effect of prevention and control is particularly evident in rural areas,which should be maintained and improved continuously.(2)Pulmonary tuberculosis,viral hepatitis and AIDS are the main death causes of infectious diseases among residents in Guangxi in the past 8 years,suggesting that publicity and intervention should be strengthened centrally with respect to the three major diseases,and targeted prevention and control measures should be adopted simultaneously.(3)The total mortality rate of infectious diseases and the mortality of major diseases are significantly higher in males than those in females,suggesting that the propaganda,as well as prevention and control of infectious diseases of male residents should be paid more attention on the whole.(4)The mortality rate of major infectious diseases in urban areas is significantly lower than that in rural areas,but the mortality rate of AIDS shows the opposite results.It is suggested that attention should be paid to the status of infectious diseases of the population with high aggregation and high mobility in the central region of urbanization,especially AIDS.The above documents that much attention should be paid to improving the propaganda and education,screening and reporting mechanism of AIDS in rural areas,especially for rural migrant workers,and improving the integrity of reporting.(5)Epidemics and deaths of infectious diseases at different ages show distinct characteristics of disease.It is suggested that targeted propaganda and prevention measures should be conducted for infectious diseases.(6)Hand-foot-and-mouth disease may have a trend of prevalence beyond the year.It may be one of the reasons for the fluctuation of the mortality rate beyond the year of infectious diseases in the 1-4 years old group.A certain degree of influenza epidemic may occur in the neighbouring region of Luocheng County in 2009.(7)There is quiet minimal difference of death level of total infectious diseases among nations.But there are differences in death level of infectious diseases among different major diseases.The epidemic situation of the infectious diseases of the Mulam ethnic minority has its own characteristics,which suggests that attention could be paid to the special humanity and natural environment in the concentrated area of nationalities.CHAPTER ? SPATIO-TEMPORAL TREND OF DEATH CAUSES SURVEILLANCE FOR NOTIFIABLE INFECTIOUS DISEASES IN 7 DISEASE SURVEILLANCE SITES IN GUANGXI FROM 2008 TO 2015[Objective] With the application of GIS technology,an analysis of the spatial distribution of death causes surveillance of notifiable infectious diseases was conducted among residents of 7 disease surveillance sites in Guangxi during 2008-2015 with the administrative village(neighborhood committee)as the measure.This study aimed to gain an insight into the spatial distribution trends of notifiable infectious diseases mortality and make comparison and comprehensive analysis,so as to provide evidence and clues for the development of scientific prevention and control strategies of infectious diseases.[Methods] After the collection of geographical information data on notifiable infectious diseases from 7 disease surveillance sites in Guangxi(Xingning District,Binyang County,Liubei District,Xiufeng District,Hepu County,Lingyun County,and Luocheng County)during 2008-2015,a digital map of monitoring sites was created by Arc GIS 10.0 software for analysis,calculation and test of the spatial distribution characteristics of infectious diseases.LISA analysis and buffer analysis were also performed through mapping regional distribution of infectious disease mortality and inverse distance weighted(IDW)interpolation to visualize the spatial distribution of mortality rates,spatial aggregation characteristics and radius,spatial correlation patterns and death risk of infectious diseases mortality.[Results](1)From the IDW and LISA analyses carried out over a time span of 1 or 2 years,it was revealed that deaths from infectious diseases in the 7 disease surveillance sites showed a trend of divergence in most regions of Guangxi with no obvious spatial aggregation characteristics.However,over a time span of 4 years,4 surveillance sites were found to have detectable aggregation areas of high mortality rates and stably low incidence rates,and the mortality rate radiated from the high-incidence area down to the surrounding area.(2)In IDW and LISA analyses with 4-year time span,no obvious spatial aggregation characteristics of the three major diseases were observed in most regions of the seven disease surveillance sites in Guangxi.(3)In Lingyun County,the mortality rate of infectious diseases was high in northeast,southwest and northwest with the central intensity of over 3/100,000,showing an H-H correlation pattern;several neighboring villages in the central area presented stably low incidence.With the passage of time,centers of high mortality rate in the high-incidence areas had shifted but still distributed along the county roads and the intersections of the county and provincial roads.(4)Liubei District showed a relatively stable aggregation areas of high death rate of infectious diseases in the central region with Shatang Street as its center.The central intensity reached over 10/100,000,presenting an H-L association model;Additionally,in the east,south,and northwest areas,the death rates remained stably low.The location of high-incidence center was obviously related to the intersections of the national and county roads.(5)In Luocheng County,the mortality rate of infectious diseases was high in the east,northeast and the west with the highest central intensity reaching over 10/100,000,showing an H-H association pattern,while it was stably low in the northwest area.The intensity and radiation radius were declining over time in high incidence areas except in the east.The death rate in east aggregation area was obviously affected by the junctions of provincial roads.(6)In Xingning district,infectious diseases produced high death rate in the midwest and east area,and its central intensity reached over 5/100,000,presenting an H-H correlation model.Two relatively stable low-incidence regions were observed in the east of central area and west area.It was also found that the midwest high-incidence belt moved southwards along the county roads and the intersections of the national and county roads;An significant decrease was detected in the intensity and radiation radius of the high-incidence centers in the east.(7)In Xiufeng district,no obvious aggregation areas with high death rate of infectious diseases had been observed,but the distribution of high-incidence areas might be affected by the national roads.[Conclusion](1)The mortality caused by notifiable infectious diseases in 4 surveillance sites of the total of 7 sites in Guangxi during 2008-2015 has spatial aggregation characteristics over a relatively large time span(e.g.,four years),suggesting that there are certain risk factors for death of infectious diseases,which have spatial distribution characteristics with certain regularity in these four regions.(2)IDW spatial interpolation and LISA analysis have certain requirements on the number of the target node values,and also on node distribution and shape.Therefore,these methods have certain limitations in the analysis of cases with small sample sizes,and other analytical methods are needed.(3)Some risk factors for death of infectious diseases exhibits a feature of mobility,thus attention should be paid to factors such as the mobility of the population with epidemic sources and vulnerable populations,the urbanization,regional economic development,and changes in medical and health conditions.(4)The transportation networks including the national,provincial and county roads have significant impacts on the location of centers with high mortality rates of infectious diseases,which is particularly affected by junctions of the national,provincial and county roads with radiation radius of 500 meters.However,township roads are not found to be related with the distribution of centers with high death rates of infectious diseases.(5)The trend of population mobility is obviously related to the spread of major infectious diseases.Efforts should be made to improve monitoring and intervention measures in areas with high death rates of infectious diseases and the adjacent areas,and spread knowledge and norms of public health for populations in epidemic area,so as to encourage the development of healthy public behaviors. |
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