| BackgroundHepatitis B is a kind of infectious disease caused by hepatitis B virus(HBV),mainly hepatocyte inflammation and damage.Among all kinds of chronic viral hepatitis,the proportion of hepatitis B is about 80%～90%,and hepatitis B will gradually evolve into cirrhosis and even liver cancer.Compared with other types of viral hepatitis,hepatitis B has seriously threatened the life safety of patients and brought huge disease burden to our country.Therefore,it is necessary to understand the epidemic characteristics and spatial distribution of hepatitis B and explore the aggregation area of hepatitis B.In addition,it is of great significance to clarify the influencing factors of hepatitis B for its prevention and control.ObjectivesThis study takes Pingyi County as a small area research scope.Based on the infectious disease database of Pingyi County Center for Disease Control and Prevention,the spatial epidemiological characteristics of hepatitis B in a small area were systematically analyzed in combination with spatial epidemiology and spatial statistics within the framework of geographic information system,so as to screen out administrative villages with high incidence of hepatitis B.Based on the analysis results,control measures were implemented in these villages to make hepatitis B prevention and control more targeted,to further investigate the correlation between Gross domestic product(GDP),air pollutants and normalized difference vegetation index(NDVI)and the incidence of hepatitis B,to provide scientific basis for the formulation of hepatitis B prevention and control strategy and measures.MethodsData of hepatitis B cases and population in Pingyi County during 2013-2022 were obtained from Pingyi County Center for Disease Control and Prevention.R4.2.2 was used to calculate the number,incidence or composition ratio of hepatitis B in Pingyi County,and to describe the time,population and regional distribution.ArcGIS 10.6 software was used to visualize the incidence of hepatitis B in each township,and spatial autocorrelation analysis was carried out.Spatial autocorrelation analysis includes global spatial autocorrelation analysis and local spatial autocorrelation analysis.Space-time scanning analysis was performed using SaTScan software.Linear Mixed effects Models(LMM)were used to explore the influencing factors of hepatitis B.Results1.The epidemiological analysis results of hepatitis B in Pingyi County from 2013 to 2022 are as follows:(1)From 2013 to 2022,the cumulative number of hepatitis B cases in Pingyi County was 6547,with an annual average incidence of 72.99/100,000.The incidence increased gradually from 2013 to 2019,and decreased rapidly from 2019 to 2022,among which the incidence exceeded the average annual incidence in Pingyi County from 2017 to 2021.Hepatitis B was found every month in Pingyi County.Except that the number of hepatitis B cases in Pingyi County had a significant monthly peak in 2015 and 2019,there was no significant monthly peak and no obvious seasonal characteristics in other years.(2)Among the 6547 cases of hepatitis B patients,4258 cases were male,accounting for 65.04 percent of the total cases.Female 2289 cases,accounting for 34.96 percent of the total cases.The annual incidence of male was higher than that of female,and the sex ratio of male to female was 1.86:1.In this study,Chi-square test was carried out for the incidence rate of hepatitis B in men and women in each year,and the results showed that there were statistical differences between the incidence of hepatitis B in men and women every year.Overall,the differences between men and women are decreasing.In Pingyi County,people aged 41 to 60 years old have a high incidence of hepatitis B in the past decade.Among the hepatitis B cases from 2013 to 2022,the top three occupations in terms of cumulative incidence were farmer,housework,unemployed and worker.(3)The district with the largest cumulative number of cases over the past decade was Pingyi Subdistrict.Pingyi Subdistrict,Baotai Town,Bianqiao Town and Wenshui town were the areas with high incidence of hepatitis B,and the incidence risk was higher than the average level of Pingyi County.From 2013 to 2016,the incidence increased significantly in Pingyi Street and Bianqiao town.In 2014,the overall incidence rate of each township was lower.The incidence of hepatitis B increased in all townships from 2017 to 2019 and reached a peak in 2019.From 2020 to 2022,the incidence rate in each township began to decline.2.The results of spatial epidemiological analysis of hepatitis B in Pingyi County from 2013 to 2022 are as follows:(1)Except 2013 and 2017,the Moran index of hepatitis B incidence in Pingyi County was greater than 0 and had statistical significance.It is suggested that the incidence of hepatitis B in Pingyi County in recent years presents a spatial aggregation distribution.The overall performance in 2019 was the highest,with the Moran’s I of 0.134.(2)From 2013 to 2015 HH clusters mainly in Pingyi subdistinct.In 2016,some administrative villages in Bianqiao Town also changed from non-HH to HH clusters.After 2017,HH clusters began to spread around and appeared successively in some administrative villages of Botai Town,Baiyan Town and Difang Town.LL clusters are blue areas,mainly in the town of Fengyang from 2017 to 2021.(3)Under the test level of α=0.05,the hottest spots are Pingyi street.In 2013 and 2014,there were many hot spots in Zhongcun Town located in the north of Pingyi County.Since 2015,the hot spots in Zhongcun disappeared and began to appear in the towns in the east and south of Pingyi.(4)The incidence of hepatitis B in Pingyi County during 2013-2022 was analyzed by temporal and spatial scanning.The results showed that the incidence of the disease had a spatiotemporal aggregation distribution.The cluster is located in the eastern part of Pingyi Subdistrict,the northern part of Tongshi Town,Botai Town,Wenshui Town,Bolin Town and Bianqiao Town,and contains 259 administrative villages.The aggregation time was from 2017 to 2021,and RR was 1.94,indicating that the risk of hepatitis B in this cluster was 1.94 times that in the surrounding area.3.The linear effects mixed model analysis showed that PM2.5,NDVI and GDP were significantly correlated with the incidence of hepatitis B(P<0.05).NDVI was negatively correlated with the incidence of hepatitis B.Conclusions1.The incidence of hepatitis B in Pingyi County from 2013 to 2022 showed an overall trend of first increasing and then decreasing,and reached the highest level in 2019.The disease occurs all year round,with no obvious seasonal characteristics.Men have a higher risk of hepatitis B than women.Farmers are the main group affected by the disease.The main age group with high incidence are the people aged from 41 to 60 years old.The high incidence areas are mainly Pingyi Subdistrict,Baotai Town,Bienqiao Town and Wenshui Town.2.Except 2013 and 2017,the incidence of hepatitis B in Pingyi County showed a spatial aggregation,showing a positive spatial correlation.There are both high value aggregation and low value aggregation in local areas.The hot spots are mainly concentrated in the middle of Pingyi County and the administrative villages in the east and middle towns.3.The results of space-time scanning analysis showed that a cluster occurred in the administrative villages in the middle and northeast of Pingyi,which should be paid more attention to in the prevention and treatment of hepatitis B.4.The incidence of hepatitis B is related to PM2.5,GDP and NDVI. |
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