| Tuberculosis(TB)is an infectious disease of the lungs caused by the Mycobacterium tuberculosis(Mycobacterium tuberculosis),which is spread mainly by droplets.In order to eliminate the damage caused by tuberculosis,countries around the world have taken various measures to fight tuberculosis,but due to the high incidence of tuberculosis,multiple drug resistance,HIV/AIDS,tuberculosis is still a major global health problem.China is one of the countries with a high TB burden,ranking second in the world.Although the incidence of tuberculosis in China is on the decline,the situation in some areas is still not optimistic,and it is still a challenge to achieve the strategic goal of complete elimination of tuberculosis by 2035.Considering the spatiotemporal aggregation of tuberculosis,this study used spatial epidemiological analysis method to carry out a systematic study of tuberculosis in China,analyze the spatiotemporal distribution characteristics,explore the high-risk areas and influencing factors of tuberculosis,and provide theoretical basis for tuberculosis prevention and control measures.MethodCollected through public health science data center from 2005 to 2016 in 31provinces(municipalities directly under the central government,autonomous regions,including Taiwan and Hong Kong,Macao special administrative region)tuberculosis incidence data of China statistical yearbook to collect demographic data all over the country provinces and cities,related macro factors,from the national fundamental geographic information system to collect the provincial regional electronic map,to carry out the following research:1.General descriptive analysis,seasonal index method and spatial trend analysis were used to analyze the epidemiological characteristics of tuberculosis in China from2005 to 2016.2.Spatial autocorrelation analysis and SATSCAN spatial and temporal scanning were used to analyze the clustering area,time and scope of tuberculosis incidence in China from 2005 to 2016,to explore the high-risk areas of the disease and to evaluate the risk intensity.3.The use of the space regression model,with per capita GDP(RMB ten thousand/person),population density(people/km~2),PM2.5(ug/m~3),medical beds(a/one thousand),medical personnel(people/one thousand),rural residents per capita spending on health care(yuan),and other six indicators as independent variables,the study of macroeconomic factors affect the incidence of tuberculosis.Results1.2005-2016,the national 31 provinces(municipalities directly under the central government,autonomous regions)total of 12187515 cases,pulmonary tuberculosis cases were reported incidence of annual report for ten thousand people,76.18/10 annual incidence showed a trend of decline(χ~2=8.167,P<0.01),with an average annual decline rate is 3.09%;The incidence in males was significantly higher than that in females.In the age distribution,the incidence rate was higher in middle-aged and elderly people(over 50 years old);In the occupational composition,farmers accounted for a large proportion(7570,440 cases,accounting for 62.12%);The number of cases with bacteria(-)was at most 5736550(47.07%),and the number of cases reported only in peiyang was at least 25014(0.21%).It has obvious seasonality and periodicity,the peak of the disease mainly concentrated in January and March,spring and summer is the peak season of the disease;Visualized maps show that the high incidence areas are mainly concentrated in the central and western regions of China.The three-dimensional trend showed that the annual incidence of tuberculosis in China had a large spatial difference,which increased rapidly from east to west,and showed a U-shaped trend of high on both sides and low in the middle from south to north.2.The global autocorrelation Moran’s I index was all higher than the expected value(E(I)=-0.0333),and the Moran’s I index ranged from 0.2248 to 0.4731 with P values less than 0.05,indicating that there was a significant positive spatial correlation between the distribution of tuberculosis incidence in China.The local autocorrelation analysis showed that most of the local hot spots of tuberculosis incidence in China from 2005 to2016 were concentrated in the western region of China.The H-H region was Hunan from2005 to 2008,Xinjiang,Qinghai and Hunan from 2009 to 2010,and Xinjiang,Tibet,Qinghai and Sichuan from 2011 to 2016.L-L region is mainly concentrated in Beijing,Jiangsu,Hebei;Were detected a kind of accumulation and three second gathering area,including a possible ghettos covers six provinces(xinjiang uygur autonomous region,Tibet autonomous region,qinghai province,gansu,sichuan and yunnan province),the center in the east longitude 91.11°and 29.41°north latitude,time of 2009.1-2012.6months,mainly located in the central and western areas in China(RR=1.41,LLR=104632,P<0.01).3.According to the spatial lag model and spatial error model,per capita GDP and per capita medical care expenditure of rural residents are negatively correlated with the incidence of tuberculosis,that is,the lower per capita GDP and the less per capita medical care expenditure of rural residents are,the higher the incidence of tuberculosis is.Conclusions1.The overall incidence of tuberculosis in China showed a decreasing trend from2005 to 2016,and the incidence of tuberculosis in males was higher than that in females.The middle-aged and elderly people and farmers were the main groups of tuberculosis incidence.2.There is an obvious spatial positive correlation between the incidence of tuberculosis in China and the degree of clustering is getting stronger.The clustering time is mostly from January to June each year,among which the central and western regions of China are the regions with high incidence of tuberculosis.3.Socio-economic level(per capita GPD and per capita medical care expenditure of rural residents)is an important factor affecting the incidence of tuberculosis in China,and the incidence is higher in areas with low economic development level. |
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