Page 33 - 2023-04-中国全科医学

·418· http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn February 2023, Vol.26 No.4

and control strategies of these two types of diseases. Methods Data on the incidence of types A and B intestinal infectious
diseases〔including typhoid and paratyphoid，viral hepatitis（hepatitis A，hepatitis E and undifferentiated type of hepatitis）
and dysentery〕in all regions of China（n=31，except for Hong Kong，Macao and Taiwan）from January 2008 to December
2018 were extracted in March 2022，using the Data-center China Public Health Science as the data source. The chi-square
test for trend was used to examine the temporal trend of incidence of these two types of diseases. Descriptive epidemiology，
spatial autocorrelation，and spatial and temporal clustering analysis were used to analyze the spatio-temporal epidemiological
characteristics of the diseases，and to determine the key seasons and regions for epidemic prevention and control. Results A
cumulative total of 3 220 480 cases of types A and B intestinal infectious diseases were reported in China from 2008 to 2018，
with an average annual incidence rate of 7.25/100 000，showing a decline in overall incidence rate（P<0.05）. The incidence
rate of typhoid and paratyphoid，viral hepatitis and dysentery demonstrated a downward trend during the period（P<0.05）. The
incidence rate of typhoid and paratyphoid decreased from 1.18 per 100 000 population in 2008 to 0.78 per 100 000 population in
2018. The incidence rate of viral hepatitis decreased from 9.81 per 100 000 population in 2008 to 4.34 per 100 000 population
in 2018. The incidence rate of dysentery decreased from 23.65 per 100 000 population in 2008 to 6.56 per 100 000 population in
2018. Typhoid，paratyphoid and dysentery occurred more frequently in summer and autumn（from May to October），while
the incidence of viral hepatitis had no obvious changes across seasons. The spatial distribution map of types A and B intestinal
infectious diseases in China indicated that，typhoid and paratyphoid had a high incidence rate in Yunnan，Guizhou and Guangxi
in western China，viral hepatitis showed a high incidence rate in western China，and dysentery had a high incidence rate in
Beijing and Tianjin. The spatial autocorrelation analysis showed that the incidence rate of typhoid and paratyphoid（except that in
2014），viral hepatitis（except that in 2016）and dysentery in China over the years from 2008 to 2018 was spatially clustered
（global Moran's I ranged from 0.09 to 0.24，P<0.05）. The spatial clustering of typhoid and paratyphoid and viral hepatitis was
decreased first and then increased，and that of viral hepatitis declined first and then rose，but was weakened in general. The
spatial clustering of dysentery was strong. The spatio-temporal scan statistics detected that Yunnan was the region with the highest
incidence rate（the primary geographic cluster）of typhoid and paratyphoid during 2009 to 2013，nine regions with Tibet as
the center had the highest incidence rate of viral hepatitis from 2008 to 2011，and Beijing and Tianjin were the regions with the
highest incidence rate of dysentery from 2008 to 2012. Conclusion Having obvious spatial and temporal clustering characteristics，
the incidence of types A and B intestinal infectious diseases in China decreased significantly during the period due to effective
prevention and control. Our study may be used as a guide to identify key prevention and control areas and to develop prevention and
control strategies according to the spatial clustering patterns of different intestinal infectious diseases.
【Key words】 Enteric infectious diseases；Spatial and temporal distribution characteristics；Epidemiology；Spatial
autocorrelation；Spatial and temporal scan；Burden of illness；Trend analysis

肠道传染病是由多种细菌、病毒、真菌及寄生虫引 间序列分析和预测 ［4，6］ ；按不同性别、年龄和职业分
起的，以恶心、呕吐、腹痛、腹泻为主要症状的经消化 析某种肠道传染病发病率的变化趋势和季节性变化规
道传播的疾病 ［1］ 。此类疾病对于各年龄段人群普遍易 律 ［7-8］ ；通过空间统计方法，分析特定时间范围内某一
感，具有传染性强、传播途径广泛而复杂、疾病负担重 空间尺度下肠道传染病发病的时空聚集性及空间分布模
等特点 ［2-4］ 。随着经济社会的发展、生态环境和人类 式 ［4，9-10］ 。以市（县）为空间尺度的研究 ［7-8，10］ 居多，
行为方式的变化、各项卫生防控措施的落实，肠道传染 全国范围、长时间序列的时空聚集分析研究较少。基于
病的流行特征发生了较大的变化，但将全国甲乙类法定 此，本研究分析 2008—2018 年我国甲乙类肠道传染病
报告传染病按传播途径统计，肠道传染病发病例数仍长 〔伤寒与副伤寒、病毒性肝炎（甲型、戊型和未分型肝炎）、
期居首位。中国疾病预防控制信息系统传染病监测系统 痢疾〕流行病学特点，以较大的空间尺度和较长的时间
数据显示，2018 年全国（不含香港特别行政区、澳门 跨度，结合时空扫描法与地理信息系统，分析我国甲乙
特别行政区和台湾地区）共报告甲乙类肠道传染病发病 类肠道传染病的时空分布特征，探索 2008—2018 年我
162 322 例，甲乙类肠道传染病发病率为 11.69/10 5［5］ ， 国甲乙类肠道传染病的时空聚集区域和时空聚集性的变
可见肠道传染病疫情形势仍较严峻，肠道传染病是我国 化趋势，为我国甲乙类肠道传染病的预防控制工作提供
主要的公共卫生问题之一。因此，动态追踪肠道传染病 参考与依据。
发病变化趋势和不同类型肠道传染病流行病学特征具有 1 资料与方法
迫切性。 1.1 资料来源 我国甲乙类法定报告肠道传染病包括
既往已有研究对肠道传染病病原学与流行特征进行 霍乱、脊髓灰质炎、伤寒与副伤寒、病毒性肝炎（甲型、
分析：包括对不同类型肠道传染病的发病趋势进行时 戊型和未分型肝炎）、痢疾 ［3］ ，鉴于霍乱和脊髓灰质