CAJ | 학술논문

目的分析中国手足口病(HFMD)重症病例的人群分布特点、时空聚集性及变化趋势.方法 HFMD重症病例来自2008-2013年中国疾病预防控制信息系统的数据,按卫生部诊疗指南中的诊断标准.采用时空Kulldorff扫描统计量空间扫描,单位为全国2 900个区县,扫描时间单位为月,时间跨度从2008年5月至2013年8月.用SaTScanTM 9.1软件完成分析；由ArcGIS 10.0软件绘制地图和结果可视化展示.结果中国2008-2013年监测数据分析显示,HFMD重症病例＞96％发生于5岁以下儿童；男性明显多于女性,发病率性别比为1.73～ 1.80∶1；＞84％为散居儿童.SaTScan分析显示,HFMD重症病例发病有时空聚集性,时间维度多发生在每年5-7月；HFMD重症病例的空间维度多聚集在东南沿海和东中部地区.变化趋势分析显示,2008年1类聚集区域位于东南沿海地区,2009年向北移至东中部地区,2010年从东中部地区往西移动,2011年由东中部地区往东北移动,2012年由东中部地区往西北、西南扩大,涉及18个省,2013年变化趋势与2012年相同,但涉及的省份减少为13个.结论中国重症HFMD病例有时空聚集性,并存在自身变化规律.研究分析结果为卫生行政部门制定重症HFMD防控策略及引导卫生资源合理储备和分配提供科学证据.
목적 분석중국수족구병(HFMD)중증병례적인군분포특점、시공취집성급변화추세.방법 HFMD중증병례래자2008-2013년중국질병예방공제신식계통적수거,안위생부진료지남중적진단표준.채용시공Kulldorff소묘통계량공간소묘,단위위전국2 900개구현,소묘시간단위위월,시간과도종2008년5월지2013년8월.용SaTScanTM 9.1연건완성분석；유ArcGIS 10.0연건회제지도화결과가시화전시.결과 중국2008-2013년감측수거분석현시,HFMD중증병례＞96％발생우5세이하인동；남성명현다우녀성,발병솔성별비위1.73～ 1.80∶1；＞84％위산거인동.SaTScan분석현시,HFMD중증병례발병유시공취집성,시간유도다발생재매년5-7월；HFMD중증병례적공간유도다취집재동남연해화동중부지구.변화추세분석현시,2008년1류취집구역위우동남연해지구,2009년향북이지동중부지구,2010년종동중부지구왕서이동,2011년유동중부지구왕동북이동,2012년유동중부지구왕서북、서남확대,섭급18개성,2013년변화추세여2012년상동,단섭급적성빈감소위13개.결론 중국중증HFMD병례유시공취집성,병존재자신변화규률.연구분석결과위위생행정부문제정중증HFMD방공책략급인도위생자원합리저비화분배제공과학증거.
Objective The purpose of this study was to analyze the distribution,temporal and spatial clustering characteristics and changes of severe hand,foot,and mouth disease (HFMD) in order to provide evidence-based decision making strategy for control and prevention of severe HFMD cases.Methods Severe HFMD cares were extracted from the National Diseases Reporting System of Chinese Center for Disease Control and Prevention (CDC) between 2008 and 2013.Definition and clinical diagnostic criteria of severe HFMD cases were set up by China CDC in the Hand,Foot,and Mouth Disease Control and Prevention Guideline,version 2010.Spatial scan unit was under the district/county of 2 900 in mainland China with temporal scan unit as month and time span as from May 2008 to August 2013.Kulldorff scan statistics was applied and analyses were conducted by SaTScanTM 9.1.Mapping and visualizing the results were carried out with ArcGIS 10.0.Results Data related to the monitoring program on severe HFMD from 2008 to 2013 demonstrated that above 96％ of the severe HFMD cases occurred under 5 years old,mostly males,with the ratio of males to females as 1.73-1.80 and over 84％ of the children were ‘scattered'.Results from SaTScan illustrated that the temporal and spatial clustering existed among severe HFMD cases.The temporal dimension of severe HFMD was from May to July each year.Spatial dimension was located in south-east coastal area and middle-east area.With respect to the changes of temporal and spatial clustering phenomena,Class 1 clustering area was located in south-east coastal region in 2008 and in middle-east region in 2009 and was shifting to the west from middle-east region in 2010.It moved to the north-east from middle-east region in 2011 and to the north-west and south-west from middle-east region in 2012.Class 1 clustering area covered districts/countries from 18 provinces in 2012.The same pattem of Class 1 clustering area was observed as in the previous year-2013,but with less districts/countries from the 13 provinces.Conclusion Temporal and spatial clustering areas of severe HFMD were presented in this report,and the yearly changing pattern of the clustering areas was noted.Findings from this study provided evidence-based data to the decision-making authorities so as to prevent deaths from severe HFMD cases under reasonable prevention and control strategies.