| Objective The morbidity and mortality of HFMD keep on a very high level that drawing great attention from the medical institutions and the centers for disease control and prevention, since it was listed into C class infectious disease management by the ministry of health of the People’s Republic of China, in 2008.This study firstly aimed to understand the epidemiological characteristics and epidemic regularty of HFMD in Chongqing; Secondly to grasp the spatial distribution characteristics of HFMD on the macroscopic level and discuss the influence of Population^ economy、health factors on HFMD morbidity so as to provide scientific reference for HFMD early warning.Method Data of daily HFMD cases、population(population density)、economic factors(per capital GDP、urbanization rate、per capita disposable income of urban residents、per capita net income of rural residents、expenditure for education、expenditure of public health) and health factors(medical technical personnel、number of health care institutions) were collected from 2008 to 2013 in 38 regions of Chongqing in this study. Firstly descriptive epidemiological method was used to know the temporal、spatial、population-based distributional characteristic of HFMD in Chongqing; Secondly the spatial autocorrelation method including global autocorrelation and local autocorrelation was carried out using the HFMD data of 38 districts (counties) from 2008 to 2013 in Chongqing,so as to explore the spatial clustering of HFMD cases; finally spatial panel data model was used to analyze the influence of population feature、economic factors and health factors on HFMDResult From 2008 to 2013, totally 11595 HFMD cases were reported, with an average annual incidence of 64.07/100000,including 89 deaths with an average annual mortality rate of 0.51/100000. The male cases were greater than female; 96.56% patients aged at and below five years old, mainly were scattered children (58.97%) and kindergarten children (36.94%);Cases were distributed in each counties and districts of the city,The incidence rate in major nine districts was higher than that in other remote suburbs; There was an obvious seasonal trend and single-epidemic peak ranged from April to July in the past four years, however, a more higher peak occurred additionally from October to December in 2012 and 2013; Poisson regression analysis result indicated that older agewere the protective factors of death in patients with HFMD, relative risk of 1、2、4 and 5 years old group of reduced in turn, which was 0.1473、0.1325、 0.0130、0.0158,respectively,indicating that the younger the children is,the easier they die. Compared with other occupation, occupation for scattered children are the risk factor of death in patients with HFMD (RR=4.8506).The global Moran’s I coefficient of Chongqing from 2009-2013 was 0.4587,0.5675、0.3986、0.6060、0.5847 with p<0.01, respectively, indicating that the incidence of HFMD in Chongqing had a positive Spatial correlation in this four years, however, no global spatial autocorrelation was founded in 2008 by the reason of the global Moran’s I coefficient was 0.1334 with p>0.05; The results of local autocorrelation suggested that there had four clustered types, namely high-high clustering、low-low clustering、high-low clustering、low-high clustering; as time goes on, the clustering pattern changed from more to less, mainly was high-high and low-low clustering areas finally; Of which high-high clustering areas were primarily concentrated in the nine districts of the central city with basically remaining the same pattern; low-low clustering areas had a tendency to transfer from middle east to southeast of Chongqing and expand year by year. The fitting results of spatial panel data model indicated that there was a positive correlation between HFMD incidence and urbanization rate (p=6.0047), there was a negative correlation between HFMD incidence and the logarithm of average per capita expenditure on health (p=-2.5848).Conclusion There were obvious gender、age、occupation、region、 season differences about incidence of HFMD cases in Chongqing from 2008 to 2013; Age、occupation and severe cases affected the HFMD deaths.In general, the incidence of HFMD was found geographically clustered in Chongqing from 2009 to 2013.We should actively seek favorable factors in low-low clustered areas to control the disease in drawing lessons from high-high clustered areas at the same time. Spatial panel data model is suitable for HFMD monitoring data in Chongqing, in the future researches need further promotion to make it in the field of public health field to play a bigger role in monitoring and decision making. |
PDF Full Text Request