2010—2022年广东省肾综合征出血热流行特征及时空聚集性分析

韩啸宇; 谭小华; 罗傲; 杨宇威; 张萌

doi:10.16462/j.cnki.zhjbkz.2024.06.002

2010—2022年广东省肾综合征出血热流行特征及时空聚集性分析

doi: 10.16462/j.cnki.zhjbkz.2024.06.002

韩啸宇^{1, 2},
谭小华³,
罗傲³,
杨宇威³,
张萌^3, ,

1.
中国疾病预防控制中心中国现场流行病学培训项目，北京 100050
2.
天津市滨海新区疾病预防控制中心传染病防控科，天津 300453
3.
广东省疾病预防控制中心传染病预防控制所，广州 511430

基金项目:

广东省医学科学技术研究基金项目 B2021113

详细信息

通讯作者:
张萌，E-mail: ccmeng0914@163.com

中图分类号: R211
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- 被引次数: 0
出版历程
- 收稿日期: 2024-03-18
- 修回日期: 2024-05-28
- 网络出版日期: 2024-07-13
- 刊出日期: 2024-06-10

Epidemic characteristics and spatiotemporal clustering of hemorrhagic fever with renal syndrome in Guangdong Province, 2010-2022

HAN Xiaoyu^{1, 2},
TAN Xiaohua³,
LUO Ao³,
YANG Yuwei³,
ZHANG Meng^{3
, ,}

1.
Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
2.
Binhai New Area Center for Disease Control and Prevention, Tianjin 300453, China
3.
Center for Disease Control and Prevention, Guangzhou 511430, China

Funds:

Guangdong Medical Science and Technology Research Fund Project B2021113

More Information

Corresponding author: ZHANG Meng, E-mail: ccmeng0914@163.com

摘要

摘要: 目的回顾性分析2010—2022年广东省肾综合征出血热(hemorrhagic fever with renal syndrome, HFRS)流行特征和时空聚集性，为探索HFRS高危地区和制定防控措施提供参考。方法 HFRS数据来源于中国疾病预防控制信息系统，运用Joinpoint 4.6.0.0软件对HFRS报告病例数据进行趋势分析，运用GeoDa 1.16软件开展全局和局部空间自相关分析，使用SaTScan 10.1软件进行时空扫描，通过计算对数似然比(log-likelihood ratio, LLR)分析HFRS时空聚集性。结果 2010—2022年广东省累计报告HFRS病例4 322例，年均发病率为0.31/10万，利用平均年度变化百分比(average annual percent change，AAPC)来评价整体趋势性变化，发病率整体呈下降趋势(AAPC=-8.4%, 95% CI：-12.6%~-3.9%)。3—4月为HFRS高发月份(RR=1.61, LLR=82.78, P=0.001)。珠三角地区、男性、30~69岁人群发病率最高。职业以家务及待业(973例，占22.51%)、商业服务(726例，占16.80%)、工人(645例，占14.92%)和农民(638例，占14.76%)居多。HFRS发病存在空间聚集性，“高-高”聚集区主要分布在珠三角地区的广州市和佛山市。时空扫描分析结果显示，1个一类聚集区位于广州市、佛山市的9个县(区)，发生在2013年2—3月；2个二类聚集区主要涉及珠三角地区的7个地级市和粤西地区的阳江市的25个县(区)，发生在2015年1—2月和2017年5—6月。每年的聚集区均出现在珠三角地区，不同年份涉及的地级市和县(区)有所不同，主要集中在广州市、佛山市，主要发生在冬春季，少数年份在夏季初。结论 2010—2022年广东省HFRS发病率呈下降趋势，发病存在季节性和空间聚集性，冬春季为高发季节，珠三角地区为高发区域，中老年为主要高发人群。
- 肾综合征出血热 /
- 空间自相关 /
- 时空聚集性
Abstract: Objective To conduct a retrospective analysis of the monitoring data on hemorrhagic fever with renal syndrome (HFRS) in Guangdong Province from 2010 to 2022, and explore characteristics and spatiotemporal clustering of HFRS data, so as to identify high-risk areas for HFRS and provide references for the development of targeted prevention and control measures. Methods The data on HFRS were obtained from the Chinese National Disease Reporting Information System. We conducted a trend analysis of HFRS case data using Joinpoint 4.6.0.0 and assessed spatial autocorrelation with GeoDa 1.16. Spatio-temporal clusters were identified using SaTScan 10.1, where the log-likelihood ratio (LLR) indicated the strength of clusters. Results From 2010 to 2022, Guangdong reported 4 322 HFRS cases, with an average annual incidence rate of 0.31 per 100 000. The incidence rate exhibited a decreasing trend (AAPC=-8.4%, 95% CI: -12.6%--3.9%). Peak cases occurred in March and April (RR=1.61, LLR=82.78, P=0.001). Males and those aged 30-69 were disproportionately affected. The Pearl River Delta, especially Guangzhou and Foshan, reported the highest incidence. Occupationally, those engaged in household chores and unemployed individuals (n=973, 22.51%), commercial service personnel (n=726, 16.80%), workers (n=645, 14.92%), and farmers (n=638, 14.76%) were relatively numerous. Spatial clustering was evident, with clusters centered in the Pearl River Delta. Spatio-temporal analysis identified clusters in Guangzhou, Foshan, and other regions of Guangdong. HFRS occurred primarily in winter and spring, with occasional summer outbreaks, consistently affecting the Pearl River Delta, particularly Guangzhou and Foshan. The spatial clustering of HFRS cases is prominent, with "high-high" clusters concentrated in Guangzhou and Foshan within the Pearl River Delta. Through spatiotemporal scanning analysis, we identified one type Ⅰ cluster encompassing nine counties in Guangzhou and Foshan from February to March 2013. Additionally, two type Ⅱ clusters were detected, occurring in January to February 2015 and May to June 2017, respectively. One affected seven cities in the Pearl River Delta, while the other encompassed 25 counties in Yangjiang City in West Guangdong. Annual scans showed that while HFRS primarily occurs in winter and spring, there are occasional early summer outbreaks. The affected cities and counties vary annually, but the Pearl River Delta, especially Guangzhou and Foshan, remains a consistent focal point. Conclusions The incidence of HFRS in Guangdong shows a downward trend. HFRS occurs frequently in winter and spring. The middle-aged and the elderly are the main groups with high incidence. The disease exhibits seasonal and spatial clustering characteristics, with the Pearl River Delta region being the high-incidence area.
- Hemorrhagic fever with renal syndrome /
- Spatial autocorrelation /
- Spatio-temporal aggregation

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图 1 广东省2010—2022年HFRS病例发病时间分布图

HFRS: 肾综合征出血热。

Figure 1. Time distribution of HFRS cases in Guangdong Province, 2010-2022

HFRS: hemorrhagic fever with renal syndrome.

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图 2 2010—2022年广东省HFRS局部空间自相关分析LISA聚集图

HFRS: 肾综合征出血热; “高-高”聚集表示这些区域为HFRS高发区域的聚集区，需对该区域重点关注；“低-低”聚集表示这些区域为HFRS低发区域的聚集区，应进一步提高监测敏感性。

Figure 2. Local indicators of spatial association (LISA) aggregation map of HFRS local spatial autocorrelation analysis in Guangdong Province, 2010-2022

HFRS: hemorrhagic fever with renal syndrome; "High-high" clustering areas refer to regions with high HFRS incidence surrounded by similar areas; These areas require close attention; "Low-low" clustering areas with low HFRS incidence need enhanced monitoring sensitivity for precise evaluation.

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图 3 2010—2022年广东省HFRS时空扫描分析聚类地图

HFRS: 肾综合征出血热。

Figure 3. HFRS spatiotemporal scanning analysis cluster map of Guangdong Province, 2010-2022

HFRS: hemorrhagic fever with renal syndrome.

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表 1 广东省2010—2022年HFRS发病情况及其变化趋势

Table 1. The incidence and trend of HFRS in Guangdong Province, 2010-2022

变量Variable	累计报告病例数 Cumulative reported cases	平均年发病率 /10万^-1 Average annual incidence rate/100 000^-1	整体趋势Overall trend		分区段趋势Segmented trend
变量Variable	累计报告病例数 Cumulative reported cases	平均年发病率 /10万^-1 Average annual incidence rate/100 000^-1	AAPC值value(95% CI)/%	P值value	起止年度Start and end year	APC值value(95% CI)/%	P值value
广东省Guangdong Province	4 322	0.306	-8.4(-12.6~-3.9)	＜0.001	2010—2014	11.8(2.5~22.1)	0.022
					2014—2018	-2.6(-13.5~9.8)	0.600
					2018—2022	-29.4(-36.9~-20.9)	0.001
地区Area
珠三角地区Pearl River Delta	3 685	0.480	-10.0(-12.8~-7.2)	＜0.001	2010—2014	9.2(3.2~15.6)	＜0.001
					2014—2018	-3.2(-10.6~4.8)	0.300
					2018—2022	-31.2(-36.2~-25.8)	＜0.001
粤东East Guangdong	289	0.129	6.2(-4.1~17.5)	0.200	2010—2014	75.7(29.3~138.7)	＜0.001
					2014—2022	-17.5(-24.7~-9.5)	＜0.001
粤西West Guangdong	194	0.095	-3.0(-11.0~5.7)	0.400	2010—2022	-3.0(-11.0~5.7)	0.400
山区Mountain region	154	0.072	-1.0(-9.1~7.8)	0.800	2010—2022	-1.0(-9.1~7.8)	0.800
性别Gender
男性Male	3 243	0.483	-7.7(-11.5~-3.8)	＜0.001	2010—2017	6.7(1.7~12.0)	＜0.001
					2017—2022	-24.7(-31.6~-17.2)	＜0.001
女性Female	1 079	0.146	-9.1(-16.8~-0.6)	＜0.001	2010—2013	21.4(-7.9~60.0)	0.100
					2013—2018	-3.4(-16.2~11.4)	0.600
					2018—2022	-32.2(-45.5~-15.6)	＜0.001
年龄组/岁Age group/years
0~＜10	4	0.002	-3.4(-5.2~-1.5)	＜0.001	2010—2022	-3.4(-5.2~-1.5)	＜0.001
10~＜20	122	0.058	-5.0(-15.0~6.2)	0.300	2010—2022	-5.0(-15.0~6.2)	0.300
20~＜30	837	0.300	-10.1(-16.0~-3.7)	＜0.001	2010—2018	-2.0(-6.7~2.8)	0.400
					2018—2022	-24.2(-39.3~-5.4)	＜0.001
30~＜40	995	0.452	-12.9(-16.9~-8.7)	＜0.001	2010—2018	-1.4(-5.1~2.4)	0.400
					2018—2022	-32.0(-41.3~-21.2)	＜0.001
40~＜50	1 089	0.512	-9.7(-13.7~-5.4)	＜0.001	2010—2017	3.8(-1.4~9.3)	0.100
					2017—2022	-25.6(-33.3~-17.1)	＜0.001
50~＜60	747	0.502	-1.9(-10.8~8.0)	0.700	2010—2013	58.2(14.4~118.9)	＜0.001
					2013—2018	0.6(-14.2~17.9)	0.900
					2018—2022	-33.5(-45.8~-18.3)	＜0.001
60~＜70	377	0.459	-8.1(-17.9~3.0)	0.100	2010—2013	38.5(-6.3~104.6)	0.100
					2013—2018	0.3(-15.3~18.8)	1.000
					2018—2022	-39.4(-53.4~-21.2)	＜0.001
70~＜80	113	0.220	-3.5(-14.7~9.3)	0.500	2010—2022	-3.5(-14.7~9.3)	0.500
≥80	38	0.170	-7.9(-15.2~0.1)	0.100	2010—2022	-7.9(-15.2~0.1)	0.100
注：HFRS, 肾综合征出血热；AAPC，年均百分比变化；APC，年度百分比变化。 Note: HFRS, hemorrhagic fever with renal syndrome; AAPC, average annual percent change; APC, annual percent changes.

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表 2 广东省2010—2022年HFRS全局空间自相关分析结果

Table 2. Spatial autocorrelation analysis results of HFRS in Guangdong Province, 2010-2022

年份 Year	Moran′s I	s	Z值 value	P值 value
2010	0.296 2	0.056 6	5.368 1	0.001
2011	0.371 1	0.061 0	6.235 4	0.001
2012	0.582 6	0.060 0	9.815 0	0.001
2013	0.441 0	0.056 1	8.033 2	0.001
2014	0.489 1	0.058 6	8.483 1	0.001
2015	0.390 6	0.058 1	6.858 4	0.001
2016	0.411 7	0.059 6	7.047 1	0.001
2017	0.402 4	0.062 7	6.512 3	0.001
2018	0.353 7	0.061 2	5.868 5	0.001
2019	0.408 0	0.058 7	7.068 5	0.001
2020	0.191 1	0.061 5	3.179 5	0.002
2021	0.274 4	0.060 6	4.627 7	0.001
2022	0.171 2	0.059 3	3.046 5	0.011
注：HFRS, 肾综合征出血热。 Note: HFRS, hemorrhagic fever with renal syndrome.

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表 3 广东省2010—2022年HFRS时空扫描分析结果

Table 3. HFRS spatiotemporal scanning analysis results in Guangdong Province, 2010-2022

扫描年度 Scanning year	聚集区域 Cluster area	涉及县(区)数 Number of affected districts	发生时间/(年-月) Occurrence time/(year-month)	扫描半径/km Scanning radius /km	实际病例数 Actual number of cases	期望病例数 Theoretical number of cases	LLR值 value	RR值 value	P值 value
2010—2022	一类聚集区Primary cluster	9	2013/02—2013/03	38.26	58	6.20	78.17	9.46	＜0.001
	二类聚集区A Secondary cluster A	6	2015/01—2015/02	42.35	37	6.99	31.73	5.33	＜0.001
	二类聚集区B Secondary cluster B	19	2017/05—2017/06	88.68	26	7.73	13.30	3.38	0.020
2010	一类聚集区Primary cluster	14	2010/03—2010/04	53.05	37	6.82	34.35	6.20	＜0.001
2011	一类聚集区Primary cluster	12	2011/04—2011/05	45.45	46	8.54	42.25	6.09	＜0.001
2012	一类聚集区Primary cluster	16	2012/03—2012/04	52.96	64	11.17	63.36	6.82	＜0.001
2013	一类聚集区Primary cluster	9	2013/02—2013/03	38.26	58	8.10	67.45	8.16	＜0.001
2014	一类聚集区Primary cluster	11	2014/02—2014/03	49.91	60	14.39	42.46	4.64	＜0.001
	二类聚集区Secondary cluster	4	2014/04—2014/05	42.26	15	3.48	10.53	4.42	0.028
2015	一类聚集区Primary cluster	11	2015/01—2015/02	49.91	61	13.03	49.14	5.31	＜0.001
2016	一类聚集区Primary cluster	10	2016/01—2016/02	41.24	47	9.92	40.62	5.63	＜0.001
	二类聚集区Secondary cluster	1	2016/03—2016/04	0	26	5.20	21.58	5.27	＜0.001
2017	一类聚集区Primary cluster	18	2017/04—2017/05	63.87	60	14.68	41.63	4.57	＜0.001
2018	一类聚集区Primary cluster	13	2018/01—2018/02	46.02	54	12.56	39.30	4.74	＜0.001
2019	一类聚集区Primary cluster	19	2019/05—2019/06	59.00	39	9.55	27.03	4.56	＜0.001
2020	一类聚集区Primary cluster	10	2020/05—2020/06	54.46	22	5.48	14.87	4.44	＜0.001
2021	一类聚集区Primary cluster	7	2021/03—2021/04	29.53	18	3.45	15.77	5.67	＜0.001
	二类聚集区Secondary cluster	3	2021/01—2021/02	10.48	9	1.05	11.53	8.92	0.008
2022	一类聚集区Primary cluster	1	2022/04—2022/05	0	8	0.31	18.51	27.03	＜0.001
	二类聚集区Secondary cluster	3	2022/06—2022/06	39.40	6	0.21	14.59	30.58	＜0.001
注：HFRS, 肾综合征出血热。 Note: HFRS, hemorrhagic fever with renal syndrome.

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