背景:在中国,狂犬病暴露的发病率很高,而且还在增加,导致伤者迫切需要狂犬病暴露后预防(PEP)诊所。然而,狂犬病暴露患者在狂犬病PEP诊所的空间可及性和不平等在中国鲜为人知。
方法:根据狂犬病暴露数据,PEP诊所数据,广州市居民出行起点-目的地(OD)矩阵数据,中国,我们首先描述了2020年至2022年广州市狂犬病暴露的发生率。然后,采用高斯两步浮动集水面积法(2SFCA)分析了狂犬病暴露患者对广州市狂犬病PEP门诊的空间可达性,并利用基尼系数和Moran\sI统计量来评估可达性得分的不等性和聚类性。
结果:从2020年到2022年,广州市共报告狂犬病暴露病例524,160例,发病率呈显著上升趋势,年平均发病率为932.0/100,000。空间可达性分析显示,三种场景的总体空间可达性得分(驾驶持续时间阈值[d0]=30分钟,45分钟,和60分钟)为0.30(95%CI:0.07,0.87),0.28(95%CI:0.11,0.53)和0.28(95%CI:0.14,0.44),分别。从化,黄埔,增城和南沙区的可达性得分较高,而海珠,荔湾,越秀区的空间可达性得分较低。基尼系数和Moran\sI统计表明,广州市狂犬病PEP诊所的可及性存在一定的不平等和聚集性。
结论:这项研究阐明了狂犬病PEP诊所的空间可及性的异质性,并为资源分配提供有价值的见解,以实现世卫组织到2030年零人类狗介导狂犬病死亡的目标。
BACKGROUND: The incidence of rabies exposure is high and increasing in
China, leading to an urgent demand of rabies post-exposure prophylaxis (PEP) clinics for the injured. However, the spatial accessibility and
inequality of rabies-exposed patients to rabies PEP clinics is less known in
China.
METHODS: Based on rabies exposure data, PEP clinic data, and resident travel origin-destination (OD) matrix data in Guangzhou City,
China, we first described the incidence of rabies exposure in Guangzhou from 2020 to 2022. Then, the Gaussian two-step floating catchment area method (2SFCA) was used to analyze the spatial accessibility of rabies-exposed patients to rabies PEP clinics in Guangzhou, and the Gini coefficient and Moran\'s I statistics were utilized to evaluate the inequality and clustering of accessibility scores.
RESULTS: From 2020 to 2022, a total of 524,160 cases of rabies exposure were reported in Guangzhou, and the incidence showed a significant increasing trend, with an average annual incidence of 932.0/100,000. Spatial accessibility analysis revealed that the overall spatial accessibility scores for three scenarios (threshold of driving duration [d0] = 30 min, 45 min, and 60 min) were 0.30 (95% CI: 0.07, 0.87), 0.28 (95% CI: 0.11, 0.53) and 0.28 (95% CI: 0.14, 0.44), respectively. Conghua, Huangpu, Zengcheng and Nansha districts had the higher accessibility scores, while Haizhu, Liwan, and Yuexiu districts exhibited lower spatial accessibility scores. The Gini coefficient and Moran\'s I statistics showed that there were certain
inequality and clustering in the accessibility to rabies PEP clinics in Guangzhou.
CONCLUSIONS: This study clarifies the heterogeneity of spatial accessibility to rabies PEP clinics, and provide valuable insights for resource allocation to achieve the WHO target of zero human dog-mediated rabies deaths by 2030.