| BackgroundBrucellosis has still caused great harm to the health of people in China,whose main infectious source was the infected animals.In recent years,the disease has become a prominent public health problem in rural areas of China.It is necessary to carry out in-depth study on its epidemic law and evaluate its burden of disease,so as to provide the basis for adjusting the disease control strategy and resources.The methods of temproal-spatial analysis can explore the epidemic pattern by discripting the epidemic chararistics more intuitively.At present,the systematic study about the temporal-spatial analysis of the epidemic of brucellosis in China in recent ten years has not been reported.Health-related quality of life is an important outcome indicator to measure the burden of disease and effects of health programs.However,the study of the effects of brucellosis on health-related quality of life has not been reported in our country.ObjectivesThis study aims to:1.reveal the spatial-temporal pattern of brucellosis’ epidemic in China in the recent ten years and to explore the effect of brucellosis on the health-related quality of life of patients,so as to provide scientific basis for adjusting prevention and control strategies and resources;2.proovide valuable informing for developing interventions to improve the health-related quality of life of brucellosis patients and to provide clues to the study of the burden of brucellosis.MethodsBased on the data of patients’ individual case in China from 2005 to 2014 obtained from the national statutory infectious disease reporting system,Autoregressive Integrated Moving Average Model(ARIMA)was used to analyze and predict the time trend of brucellosis’ incidecne.And the hotspot areas and temporal-spatial clusters of brucellosis’s incidence rate was also detected through the methods of disease map,the global Moran index,Getis-Ord’s statistics,time-space scanning statistics based on the county scale.The spatial-temporal clustering characteristics of brucellosis in high prevalence areas were analyzed based on township scale,by taking Shanxi Province as an example.We selected a hospital in Xinjiang as a field site to investigate the brucellosis inpatients’ health-related quality of life and related impacting factors.The patients were interviewed through the uniform questionnaire about the information of basic demographic characteristics,clinical features,medical service seeking behavior.The ED-5Q-3L scale(Chinese mainland version)developed by the European Quality of Life Association was used to evaluate the quality of life-related health of the brucellosis patients.Multiple linear regression method was used to explore the factors affecting the health-related quality of life of patients.Results1.The spatial-temporal pattern of brucellosis’ epidemic in China1.1 The temporal trendThe reported national incidence of brucellosis rose from 1.4 per 100,000 in 2005 to 4.2 per 100,000 in 2014,with an average annual growth rate of 12.9 per cent.The incidence of brucellosis in China has seasonal characteristics with the epidemic peak from March to July.A ARIMA model was established by using the historical incidence from 2001 to 2013.Based on the optimal model of ARIMA(0,1;1)(1,1,0)12,the incidence of brucellosis in 2014 was estimated.The results show that the incidence of brucellosis in China is still a significant upward trend.This model is accurate with the mean absolute percentage error(MAPE)of only 3.9%.1.2 The temporal-spatial pattern based on the provincial scaleDuring this decade the brucellosis cases reporting from the northern areas occupied of 99.0%(301685/335205)of that of the whole nation.And 79.8%(293234/335205)cases occurred in Inner Mongolia and its adjacent 8 provinces(including Heilongjiang,Liaoning,Jilin,Hebei,Shanxi,Shaanxi,Ningxia and Gansu).The number of case reported by these nine provinces occpupied 96.4%of the country in 2005.However,this proportion dropped to 69.4%in 2014.1.3 The temporal-spatial pattern based on the county scaleThe proportion of counties with reported brucellosis case increased from 17.0%in 2005 to 60.0%in 2014.The brucellosis epidemic areas expanded from the traditional pastoral areas such as Inner Mongolia,Xinjiang and Tibet,gradually to the agricultural areas such as the three northeastern provinces,Shanxi,Hebei and other central provinces,and then continually spread to the south.The number of counties with incidence more than 10.0 per 100,000 has risen to 422(14.3%)in 2014 from 125(4.2%)in 2005.And these counties mainly distributed in Inner Mongolia and neighboring 8 provinces and the proportion in these 9 provinces also showed an upward trend:from 12.6%in 2005(116/919)rose to 2014 36.2%(332/919).In China the brucellosis incidence presents spatial clustering characteristics and has hot-spot areas.In the past decade,based on the county scale,the national hot-spot areas extended from the central and eastern Inner Mongolia,gradually to the western Inner Mongolia and the surrounding areas of Heilongjiang,Liaoning,Hebei,Shanxi and Ningxia.Since 2011,Xinjiang has become one of the hot-spot areas,from its central gradually to its north and south.In this decade,there were 97 spatial-temporal clusters detected based on the county scale.Among them,95 occurred from January to August,and the spatial trend of these clusters was the same as those of the hot-spot areas.During the past decade,the primary spatial-temporal clusters’ positions were relatively stable,slightly spreading from the central and eastern parts of Inner Mongolia,to its eastern north,and then expanding towards its west and extending to the south,involving increasing number of counties.1.4 The temporal-spatial pattern based on the township scale There are also township clusters in the epidemic regions.Take Shanxi Province as an example.In 2005,the proportion of the township with reported brucellosis case in this province was 31.5%(439/1394)and this number rose to 82.5%(1153/1394)in 2014.The proportion of townships with a morbidity higher than 10.0/100,000 in the province rose from 15.3%(212/1394)in 2005 to 59.9%(887/1394)in 2014.The proportion of townships with a morbidity higher than 50.0/100,000 increased from 5.2%(72/1394)in 2005 to 12.5%(174/1394)in 2014.These townships with high incidence gradually spread from Shanxi’s eastern north to its central and its southern areas,aggregating in the basins and the adjacent plateau areas suitable for agricultural cultivation and livestock breeding.During this decade,there were 55 spatial-temporal clusters detected based on township scale in Shanxi Province.These clusters occurred mainly from January to August with the same spatial extending trend as those townships with high incidence and some spatial-temporal clusters were relatively stable in positons during the past decade.2.Health related quality of life of brucellosis in hospitalized patientsA total of 237 inpatients were surveyed,among which 62.7%were male,mean age was 41.6±15.0 years,ethnic minorities accounted for 73.0%,69.2%of the patients living in rural areas,47.3%had education degree of primary school and below and 32.1%had education degree of middle school.There were 60.2%of the patients sharing the same courtyard with the livestock.The percentage of the patients that had family members with history of brucellosis was 29.5%.Seventy-four out of the 237 patients had complications of bone and joint system,occupying 31.2%of the patients.The average hospital days was 9.3 ± 2.4 days.There were 45.6%(108/237)patients taking the primary medical institutions as the first consultation institutions,which included the hospital and clinics at county,township and village level.However,only 13.9%(15/108)of them were diagnosed as brucellosis in the first consultation.Under the worst condition,there were 19.0%of the patients failing to get out of bed,14.3%failing to wash or dress by themselves,21.9%unable to carry out daily activities,20.3%of the patients with extreme anxiety or depression,and 49.4%cases with extreme pain or discomfort.In other cases,there were 21.1%cases having problem in self-care,53.6%cases with moderate anxiety or depression,42.6%cases with moderate pain or discomfort,44.7%cases having problem with mobility disorder,34.2%cases having difficulty in daily activities.The average score of visual analog scale(VAS)was 59(SD 21)with a median of 60.The mean health utility value was 0.4900(SD 0.2900).The mean quality adjusted life days(QALDs)loss of each patient was 45.42 days(SD 63.64),i.e.,the mean loss of quality adjusted life years(QALYs)was 0.12 years(SD 0.17 years).The results of multiple linear regression analysis showed that having complications,serious underlying diseases,and a long time from onset to diagnosis were the three relating negative factors impacting the health related quality of life of the brucellosis inpatients.Conclusions and suggestions1.In the past decade,the epidemic situation of brucellosis in our country has been aggravated with yearly incidence rising and inviolved areas expanding from the northern-west and northern-east to the central and then to the south.The incidence of brucellosis presents the characteristics of spatial aggregation.The hot-spot areas of brucellosis have spread from Inner Mongolia to the neighboring areas with more and more areas involved.The national epidemic of brucellosis aloso presents the characteristics of temporal-spatial aggregation,not only based on the county polygon but also on the township polygon in high epidemic regions.2.The HRQoL of patients with brucellosis were severely damaged.The loss of quality adjusted life years(QALYs)is substantial.Having complications,having severe underlying diseases,and long time interval from onset to diagnosis are the three negative impacting factors of HRQoL of brucellosis cases.3.Above all,the disease burden of human brucellosis is heavy in China.There is an urgent need to strengthen the efforts of controlling this disease in our country,especially to invest more resources to strengthen the joint-control work in the hot-spot areas to avoid disseminating this diseas to the suroungding area.In the regions with high incidence,it is also of necessity to decentralize the prevention and control unit to the township level,and strengthen the ability of brucellosis prevention and treatment in the primary health system to improve the accessibility of medical services,achieve the prompt diagnosis and timely treatment to reduce the damage to HRQoL of the patients.Further studies on the burden of brucellosis in China should be carried out to provide scientific basis for mobilizing and allocating resource for combatting with this disease. |
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