背景:世界卫生组织宣布水痘为国际公共卫生紧急事件。自2022年1月1日以来,中国已跻身全球受水痘疫情影响最大的十大国家之列。然而,缺乏关于水痘的空间流行病学研究,这对于准确绘制疾病的空间分布和聚类至关重要。
目的:本研究旨在提供地理上准确的视觉证据,以确定预防和控制水痘的优先区域。
方法:在2023年6月至11月期间,从中国大陆31个省(台湾除外)收集了当地确诊的水痘病例,澳门,和香港。时空流行病学分析,包括空间自相关和回归分析,进行了研究,以确定水痘发作率的时空特征和聚类模式及其与社会人口统计学和社会经济因素的空间关系。
结果:自2023年6月至11月,中国大陆30个省共报告了1610例本地确诊的水痘病例,导致每1000万人中11.40人的攻击率。全局空间自相关分析表明,7月(MoranI=0.0938;P=.08),8月(MoranI=0.1276;P=.08),和9月(MoranI=0.0934;P=.07),水痘的发作率表现出集群模式和正的空间自相关。Getis-OrdGi*统计数据确定了北京天花发作率的热点,天津,上海,江苏,和海南。从6月到10月,北京和天津是一致的热点地区。通过Getis-OrdGi*统计,未检测到具有低天花发作率的冷点。当地的MoranI统计数据确定了广东省的高-高(HH)聚集的天花攻击率,北京,和天津。广东省从6月到11月一直表现出HH集群,而北京和天津在7月至9月被确定为HH集群。低-低集群主要位于内蒙古,新疆,西藏,青海,和甘肃。普通最小二乘回归模型显示,天花累积发病率与城市人口比例呈显著正相关(t0.05/2,1=2.4041P=.02),人均国内生产总值(t0.05/2,1=2.6955;P=0.01),人均可支配收入(t0.05/2,1=2.8303;P=.008),人均消费支出(PCCE;t0.05/2,1=2.752;P=0.01),和PCCE用于医疗保健(t0.05/2,1=2.5924;P=0.01)。地理加权回归模型表明,水痘累积发病率与城市人口比例之间存在正相关和空间异质性,人均国内生产总值,人均可支配收入,PCCE,在中国北方和东北地区具有较高的R2值。
结论:通过局部空间自相关分析确定的水痘发作率的热点和HH聚类应被视为精确预防和控制水痘的关键领域。具体来说,广东,北京,天津市应优先进行水痘防控。这些发现提供了地理上精确和可视化的证据,以帮助确定有针对性的预防和控制的关键领域。
BACKGROUND: The World Health Organization declared mpox an international public health emergency. Since January 1, 2022, China has been ranked among the top 10 countries most affected by the mpox outbreak globally. However, there is a lack of spatial epidemiological studies on mpox, which are crucial for accurately mapping the spatial distribution and clustering of the disease.
OBJECTIVE: This
study aims to provide geographically accurate visual evidence to determine priority areas for mpox prevention and control.
METHODS: Locally confirmed mpox cases were collected between June and November 2023 from 31 provinces of mainland China excluding Taiwan, Macao, and Hong Kong. Spatiotemporal epidemiological analyses, including spatial autocorrelation and regression analyses, were conducted to identify the spatiotemporal characteristics and clustering patterns of mpox attack rate and its spatial relationship with sociodemographic and socioeconomic factors.
RESULTS: From June to November 2023, a total of 1610 locally confirmed mpox cases were reported in 30 provinces in mainland China, resulting in an attack rate of 11.40 per 10 million people. Global spatial autocorrelation analysis showed that in July (Moran I=0.0938; P=.08), August (Moran I=0.1276; P=.08), and September (Moran I=0.0934; P=.07), the attack rates of mpox exhibited a clustered pattern and positive spatial autocorrelation. The Getis-Ord Gi* statistics identified hot spots of mpox attack rates in Beijing, Tianjin, Shanghai, Jiangsu, and Hainan. Beijing and Tianjin were consistent hot spots from June to October. No cold spots with low mpox attack rates were detected by the Getis-Ord Gi* statistics. Local Moran I statistics identified a high-high (HH) clustering of mpox attack rates in Guangdong, Beijing, and Tianjin. Guangdong province consistently exhibited HH clustering from June to November, while Beijing and Tianjin were identified as HH clusters from July to September. Low-low clusters were mainly located in Inner Mongolia, Xinjiang, Xizang, Qinghai, and Gansu. Ordinary least squares regression models showed that the cumulative mpox attack rates were significantly and positively associated with the proportion of the urban population (t0.05/2,1=2.4041 P=.02), per capita gross domestic product (t0.05/2,1=2.6955; P=.01), per capita disposable income (t0.05/2,1=2.8303; P=.008), per capita consumption expenditure (PCCE; t0.05/2,1=2.7452; P=.01), and PCCE for health care (t0.05/2,1=2.5924; P=.01). The geographically weighted regression models indicated a positive association and spatial heterogeneity between cumulative mpox attack rates and the proportion of the urban population, per capita gross domestic product, per capita disposable income, and PCCE, with high R2 values in north and northeast China.
CONCLUSIONS: Hot spots and HH clustering of mpox attack rates identified by local spatial autocorrelation analysis should be considered key areas for precision prevention and control of mpox. Specifically, Guangdong, Beijing, and Tianjin provinces should be prioritized for mpox prevention and control. These findings provide geographically precise and visualized evidence to assist in identifying key areas for targeted prevention and control.