摘要
目的分析2010—2024年云南省德宏傣族景颇族自治州(以下简称“德宏”)恙虫病的流行病学特征,为优化防控策略提供科学依据。方法收集国家疾病预防控制信息系统中2010年1月1日—2024年12月31日德宏上报的恙虫病病例信息,采用Joinpoint Regression Program 5.3.0软件建立Joinpoint回归模型,计算2010—2024年德宏恙虫病报告发病率的年度变化百分比(APC)、平均年度变化百分比(AAPC)及其95%置信区间(CI),分析不同性别、地区、年龄段发病率的变化趋势。采用SPSS 25.0软件进行正态性检验和描述性统计分析。结果2010—2024年德宏累计报告恙虫病13715例,无死亡病例,年平均报告发病率为71.88/10万。2010—2022年报告发病数和报告发病率总体呈上升趋势,从2010年的117例(9.84/10万)上升至2022年的1817例(138.76/10万),2023年(1644例,124.47/10万)和2024年(1475例,108.97/10万)略有回落,但仍维持在较高水平,各年度报告发病数和发病率差异有统计学意义(χ^(2)=5318.62、4783.42,均P<0.01)。Joinpoint回归分析识别出两个趋势转折点(2016年和2022年),将发病趋势划分为3个阶段:2010—2016年发病率显著上升(APC=33.61%,P<0.01),2017—2022年仍呈上升趋势但增速趋缓(APC=13.94%,P<0.01),2023—2024年虽略有下降但无统计学意义(APC=-10.74%,P>0.05)。2010—2024年,芒市、盈江县和陇川县为高发地区,报告发病数分别为4826例(占35.19%)、3921例(占28.59%)和3151例(占22.97%),报告发病率分别为77.57/10万、84.83/10万和112.80/10万。Joinpoint回归分析显示,2010—2024年间,所有县(市)报告发病率均呈显著上升趋势(AAPC均P<0.01),其中梁河县增幅最大(AAPC=48.00%),其后依次为陇川县(AAPC=38.64%)、瑞丽市(AAPC=22.57%)、芒市(AAPC=18.47%)和盈江县(AAPC=9.14%)。发病呈明显的季节性:8月为峰值(季节指数=2.65);7—11月报告病例数占报告病例总数的84.81%(11632/13715),为流行季。人群分布中男性7799例(占56.86%),女性5916例(占43.14%),男女性别比为1.32∶1,男性和女性报告发病率变化趋势与总体一致,且均以2016和2022年为关键转折点。病例年龄分布为1月龄至96岁,中位年龄为40岁。发病主体为30~59岁青壮年人群,占报告病例总数的55.49%(7611/13715)。Joinpoint回归分析显示,各年龄组发病率在2010—2024年间均显著上升(AAPC均P<0.01),其中40~49岁组增幅最大(AAPC=19.41%,95%CI:17.36~24.60)。职业分布以农民为主,占报告病例总数的72.69%(9969/13715)。结论2010—2024年德宏恙虫病发病率总体呈快速上升态势,应针对重点地区、流行季节和高风险人群持续加强监测与防控。
Objective To investigate the epidemiological characteristics of scrub typhus in Dehong Dai and Jingpo Autonomous Prefecture,Yunnan Province from 2010 to 2024,so as to provide insights into optimization of scrub typhus control strategies.Methods Data on scrub typhus cases reported in Dehong from January 1,2010,to December 31,2024 were collected from the China Disease Prevention and Control Information System.The Joinpoint Regression Program version 5.3.0 was used to establish a Joinpoint regression model.The annual percent change(APC),average annual percent change(AAPC),and their 95%confidence intervals(CI)of the incidence of reported scrub typhus were calculated to analyze the trends in incidence by gender,region,and age group.Normality tests and descriptive statistical analyses were performed using the software SPSS 25.0.Results A total of 13715 scrub typhus cases were reported in Dehong from 2010 to 2024,with no deaths,and the annual average reported incidence was 71.88/105.The number of reported cases and reported incidence appeared an overall tendency towards a rise from 2010 to 2022,with an increase from 117 cases(9.84/105)in 2010 to 1817 cases(138.76/105)in 2022.A slight decline was observed in 2023(1644 cases,124.47/105)and 2024(1457 cases,108.97/105),although the incidence remained high.There were significant differences in the number of reported cases and the incidence among years(χ^(2)=5318.62,4783.42;both P<0.01).Joinpoint regression analysis identified two turning points(in 2016 and 2022)and the trends in incidence were divided into three phases:a significant increase from 2010 to 2016(APC=33.61%,P<0.01),a continued but slower increase from 2017 to 2022(APC=13.94%,P<0.01),and a numerical decline from 2023 to 2024(APC=-10.74%,P>0.05).Mangshi,Yingjiang County and Longchuan County were high-incidence areas from 2010 to 2024,with 4826(35.19%),3921(28.59%),and 3151(22.97%)reported cases,and average annual incidence rates of 77.57/105,84.83/105,and 112.80/105,respectively.Joinpoint regression analysis indicated that the reported incidence appeared a tendency towards a significant rise across all counties(cities)from 2010 to 2024(all P<0.01 for AAPC),with the largest increase seen in Lianghe County(AAPC=48.00%),followed by Longchuan County(AAPC=38.64%),Ruili City(AAPC=22.57%),Mangshi(AAPC=18.47%),and Yingjiang County(AAPC=9.14%).A distinct seasonal pattern was observed in the incidence,with the peak in August(seasonal index=2.65).The epidemic season was found from July to November,with the number of reported cases accounting for 84.81%(11632/13715)of the total reported cases.There were 7799(56.86%)male cases and 5916(43.14%)female cases,with a male-to-female ratio of 1.32∶1,and the trends in incidence among both genders were consistent with the overall trend,with 2016 and 2022 as key turning points.Cases were widely distributed across all age groups,ranging from 1 month to 96 years,with a median age of 40 years.The majority of cases(55.49%,7611/13715)were young and middle-aged adults aged 30 to 59 years.Joinpoint regression analysis revealed a significant increase in incidence across all age groups from 2010 to 2024(all P<0.01 for AAPC),with the largest increase seen among residents at ages of 40 to 49 years(AAPC=19.41%,95%CI:17.36 to 24.60).Farmers were the dominant occupation(9969 cases,72.69%).Conclusion The incidence of scrub typhus appeared an overall tendency towards a rapid rise in Dehong from 2010 to 2024.Continuous improvements of disease surveillance and control is recommended tailored to high-risk regions,epidemic seasons,and high-risk populations.
作者
苟长春
刘爱聪
冯凯
曹淳力
宋肖肖
岳太科
GOU Changchun;LIU Aicong;FENG Kai;CAO Chunli;SONG Xiaoxiao;YUE Taike(Dehong Dai and Jingpo Autonomous Prefecture Center for Disease Control and Prevention,Mangshi 678400,Yunnan,China;National Institute of Parasitic Diseases,Chinese Center for Disease Control and Prevention/Chinese Center for Tropical Diseases Research/National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases/NHC Key Laboratory on Parasite and Vector Biology/WHO Collaborating Centre for Tropical Diseases/National Center for International Research on Tropical Diseases,Ministry of Science and Technology,Shanghai 200025,China;Department of Epidemiology and Statistics,School of Public Health,Kunming Medical University,Kunming 650500,Yunnan,China)
出处
《中国寄生虫学与寄生虫病杂志》
北大核心
2025年第5期683-689,共7页
Chinese Journal of Parasitology and Parasitic Diseases
基金
云南省科技厅昆明医科大学应用基础研究联合专项(202301AY070001-259)
云南省教育厅公共卫生与疾病防控重点实验室资助(2023ZD08)。
关键词
恙虫病
流行特征
时间趋势
Joinpoint回归分析
Scrub typhus
Epidemiological characteristic
Temporal trend
Joinpoint regression analysis
