Spatio-temporal pattern and associate factors of bacillary dysentery disease in Shandong Province from 2005 to 2021
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摘要:
目的 分析山东省细菌性痢疾的时空特征，探讨气象、人口、经济、卫生、自然环境等因素与细菌性痢疾发病的关系。 方法 收集2005―2021年山东省细菌性痢疾的发病数据、气象数据和社会环境数据，应用贝叶斯时空模型分析细菌性痢疾的时空特征，识别细菌性痢疾发病的影响因素。 结果 2005―2021年山东省细菌性痢疾累计发病145 644例。2005―2021年山东省细菌性痢疾的发病风险总体呈下降趋势，高风险期出现在每年6―9月，威海市、淄博市、烟台市、济南市和潍坊市为细菌性痢疾发病的热点区。细菌性痢疾的发病与月平均气温(RR=1.030, 95% CI: 1.025~1.034)、月降水量(RR=1.001, 95% CI: 1.001~1.001)、人口自然增长率(RR=1.005, 95% CI: 1.002~1.007)、人均地区生产总值(RR=0.999, 95% CI: 0.999~0.999)、人均地区生产总值增长率(RR=0.987, 95% CI: 0.980~0.994)、卫生技术人员数(RR=0.999, 95% CI: 0.999~0.999)、建成区绿化覆盖率(RR=0.993, 95% CI: 0.992~0.995)有关。 结论 细菌性痢疾的发病与气象因素、社会环境因素相关，应加强高风险区细菌性痢疾的防控，在流行期及时做好健康提示和疫情处置准备。 Abstract:Objective To investigate spatio-temporal trends of bacillary dysentery in Shandong Province and explore the association between bacillary dysentery and meteorological, population, economic, hygiene and environmental factors. Methods A Bayesian space-time model was employed to identify the spatio-temporal heterogeneity of bacillary dysentery cases and quantify the potential association between bacillary dysentery cases and meteorological and social environmental variables in Shandong Province from 2005 to 2021. Results During 2005-2021, 145 644 bacillary dysentery cases were reported in Shandong Province. Temporally, the risk of bacillary dysentery showed a decreasing trend, and peaked from June to September. Geographically, hot-spot areas were distributed in Weihai, Zibo, Yantai, Jinan, and Weifang cities. The incidence risk for bacillary dysentery was associated with the monthly average temperature (RR=1.030, 95% CI: 1.025-1.034), monthly rainfall (RR=1.001, 95% CI: 1.001-1.001), natural population growth rate (RR=1.005, 95% CI: 1.002-1.007), gross domestic product (GDP) per capita (RR=0.999, 95% CI: 0.999-0.999), GDP per capita growth rate (RR=0.987, 95% CI: 0.980-0.994), number of health technicians (RR=0.999, 95% CI: 0.999-0.999), and green coverage (RR=0.993, 95% CI: 0.992-0.995). Conclusions The incidence risk for bacillary dysentery was associated with meteorological and social environmental factors. It is necessary to pay attention to high-risk areas, provide health advisories, and make preparations for epidemic response during epidemic periods. -
图 1 2005―2021年山东省细菌性痢疾发病的时间结构效应趋势
Figure 1. Temporal structure effects of bacillary dysentery in Shandong Province, from 2005 to 2021
表 1 2005―2021年山东省各地市细菌性痢疾发病率(/10万)
Table 1. Incidence rates of bacillary dysentery in Shandong Province, from 2005 to 2021 (per 100 000)
城市
City年份 Year 2005 2006 2007 2008 2009 2010 2011 2012 2013 济南市 Jinan City 42.807 34.764 29.171 19.285 12.787 10.545 11.779 8.936 5.601 青岛市 Qingdao City 20.743 13.226 10.445 7.486 5.517 4.416 6.515 4.352 2.800 淄博市 Zibo City 66.427 58.915 51.808 50.609 39.573 33.844 39.725 24.065 22.384 枣庄市 Zaozhuang City 27.257 20.670 6.128 3.741 4.659 4.320 6.229 5.404 6.379 东营市 Dongying City 12.242 11.965 9.322 9.389 5.360 5.626 7.784 5.900 5.122 烟台市 Yantai City 28.877 24.194 22.612 18.628 13.272 12.483 17.280 11.078 11.219 潍坊市 Weifang City 33.413 25.728 15.929 11.146 11.778 10.331 15.316 8.654 8.043 济宁市 Jining City 29.519 17.471 19.307 12.591 6.314 7.839 8.887 7.144 6.699 泰安市 Taian City 36.421 29.857 20.467 21.845 17.218 21.536 28.526 23.235 23.097 威海市 Weihai City 75.536 67.053 62.874 59.579 53.128 52.372 53.815 47.066 40.344 日照市 Rizhao City 13.329 9.492 10.412 5.724 3.519 2.926 4.212 1.903 2.401 临沂市 Linyi City 11.015 9.122 5.929 5.614 3.772 4.575 5.510 4.059 3.987 德州市 Dezhou City 7.907 6.643 5.043 3.170 3.020 4.001 5.069 4.475 2.627 聊城市 Liaocheng City 15.236 13.736 9.103 7.396 4.243 5.692 6.483 3.971 4.381 滨州市 Binzhou City 19.453 14.718 14.055 11.332 9.163 9.995 12.094 7.126 5.833 菏泽市 Heze City 9.195 6.046 5.719 3.664 6.110 6.276 8.295 8.971 8.664 城市
City年份 Year 2014 2015 2016 2017 2018 2019 2020 2021 济南市 Jinan City 5.405 3.561 3.456 3.155 2.949 2.761 1.948 1.692 青岛市 Qingdao City 2.675 1.528 1.423 1.012 1.128 0.884 0.327 0.361 淄博市 Zibo City 19.155 19.388 10.433 8.899 7.040 6.025 5.015 2.761 枣庄市 Zaozhuang City 6.003 4.596 4.268 2.599 2.210 1.042 0.441 0.156 东营市 Dongying City 3.970 4.619 3.610 2.849 2.022 6.056 4.149 2.415 烟台市 Yantai City 8.922 7.254 4.937 5.564 4.545 5.380 2.928 2.146 潍坊市 Weifang City 6.917 5.362 4.094 5.265 5.260 3.775 2.268 2.489 济宁市 Jining City 4.390 3.267 1.916 1.417 1.294 0.682 0.239 0.324 泰安市 Taian City 21.786 19.891 17.770 17.129 10.742 3.780 3.669 1.803 威海市 Weihai City 38.251 39.236 7.756 1.234 0.068 0.388 0.344 0.069 日照市 Rizhao City 3.419 6.733 3.271 2.108 1.378 0.882 0.404 0.269 临沂市 Linyi City 3.552 2.851 3.304 2.859 3.285 3.169 1.642 2.677 德州市 Dezhou City 2.401 2.543 2.089 1.173 0.654 0.348 0.534 0.607 聊城市 Liaocheng City 2.864 3.534 3.512 3.051 2.403 2.083 0.655 0.321 滨州市 Binzhou City 5.157 5.753 4.755 4.703 4.614 2.931 2.519 1.578 菏泽市 Heze City 7.466 5.929 5.254 4.544 4.507 3.963 2.103 1.477 
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表 2 2005―2021年山东省细菌性痢疾发病空间效应风险的后验均值及后验概率
Table 2. Posterior mean and posterior probability for the spatial effects of bacillary dysentery in Shandong Province, from 2005 to 2021
地市
City济南市
Jinan City青岛市
Qingdao City淄博市
Zibo City枣庄市
Zaozhuang City东营市
Dongying City烟台市
Yantai City潍坊市
Weifang City济宁市
Jining CityRR值 value 1.975 1.160 3.564 0.342 1.500 2.615 1.701 0.854 后验概率 Posterior probability 0.998 0.725 1.000 0.000 0.962 1.000 0.989 0.189 地市
City泰安市
Tai′an City威海市
Weihai City日照市
Rizhao City临沂市
Linyi City德州市
Dezhou City聊城市
Liaocheng City滨州市
Binzhou City菏泽市
Heze CityRR值 value 1.489 4.157 0.202 0.692 0.330 0.572 0.744 0.752 后验概率 Posterior probability 0.959 1.000 0.000 0.035 0.000 0.005 0.065 0.071
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表 3 变量筛选的单因素分析结果和多重共线性检验
Table 3. Results of univariate analysis and multicollinearity test
变量
Variable单因素分析 Univariate analysis 多重共线性检验 Multicollinearity test 回归参数
Regression parametersx P值
valueVIF 剔除后VIF
Adjusted VIF月平均气温 Monthly average temperature/℃ 0.069 0.000 < 0.05 1.665 1.662 月降水量 Monthly rainfall/mm 0.004 0.000 < 0.05 1.809 1.808 月日照时间 Monthly sunshine duration/h 0.003 0.000 < 0.05 1.307 1.302 人口自然增长率 Natural population growth rate/‰ -0.112 0.001 < 0.05 1.289 1.305 人均地区生产总值/元 Gross domestic product per capita/yuan -0.000 0.000 < 0.05 2.458 2.022 人均地区生产总值增长率 Gross domestic product per capita growth rate/% 0.134 0.001 < 0.05 3.410 2.851 地方公共预算支出/万元 Local government expenditure/10 000 yuan -0.000 0.000 < 0.05 10.639 医院床位数/张 Number of beds/beds -0.000 0.000 < 0.05 20.100 卫生技术人员数/人 Number of health technicians/persons -0.000 0.000 < 0.05 16.898 1.520 建成区绿化覆盖率 Green coverage/% -0.020 0.001 < 0.05 1.185 1.121 注：VIF, 方差膨胀因子。
Note: VIF, variance inflation factor.
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表 4 协变量的后验估计及RR值
Table 4. Posterior estimation of associated factors and RR values
变量
Variable均值
Mean95% CI 标准差
sRR值
value (95% CI)月平均气温 Monthly average temperature/℃ 0.029 (0.025~0.033) 0.002 1.030(1.025~1.034) 月降水量 Monthly rainfall/mm 0.001 (0.001~0.001) 0.000 1.001(1.001~1.001) 月日照时间 Monthly sunshine duration/h 0.000 (0.000~0.000) 0.000 1.000(0.999~1.000) 人口自然增长率 Natural population growth rate/‰ 0.005 (0.002~0.007) 0.001 1.005(1.002~1.007) 人均地区生产总值/元 Gross domestic product per capita/yuan 0.000 (0.000~0.000) 0.000 0.999(0.999~0.999) 人均地区生产总值增长率 Gross domestic product per capita growth rate/% -0.013 (-0.020~-0.006) 0.004 0.987(0.980~0.994) 卫生技术人员数/人 Number of health technicians/persons 0.000 (0.000~0.000) 0.000 0.999(0.999~0.999) 建成区绿化覆盖率 Green coverage/% -0.007 (-0.008~-0.005) 0.001 0.993(0.992~0.995)
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