背景:加速的流行病学转变,在经济发展和城市化的刺激下,导致了疾病谱的快速转变。然而,这种转变导致了城市和农村地区传染病负担的不同变化。我们的研究目的是评估儿童传染病的长期城乡差异,青少年,和中国的年轻人,同时也检查驱动这些差异的具体疾病。
结果:这项观察性研究检查了4至24岁个体的8,442,956例应报告的43种传染病的数据,在城市地区有4,487,043例,在农村地区有3,955,913例。2013-2021年数据来源于中国法定传染病监测系统。这43种传染病分为7类:疫苗可预防,细菌,胃肠道和肠道病毒,性传播和血液传播,矢量化,人畜共患,和检疫疾病。传染病发病率的计算按城乡分层。我们使用发病率比率(IRR)指数,通过将城市发病率除以每个疾病类别的农村发病率来计算,评估城乡差距。在九年的学习期间,城市和农村地区的大多数法定传染病表现出减少或稳定的模式。然而,观察到应报告传染病的城乡差距显着并且逐渐扩大。孩子们,青少年,城市地区的年轻人比农村地区的年轻人经历了更高的平均年发病率,比率分别为439/100,000,而211/100,000(IRR:2.078,95%CI[2.075,2.081];p<0.001)。从2013年到2021年,这种差异主要是由于百日咳(IRR:1.782,95%CI[1.705,1.862];p<0.001)和季节性流感(IRR:3.213,95%CI[3.205,3.220];p<0.001)在疫苗可预防的疾病中,结核病(IRR:1.011,95%CI[1.006,1.015];p<0.001),和猩红热(IRR:2.942,95%CI[2.918,2.966];p<0.001)感染性腹泻(IRR:1.932,95%CI[1.924,1.939];p<0.001),手,脚,胃肠道和肠道病毒疾病中的口蹄疫(IRR:2.501,95%CI[2.491,2.510];p<0.001),登革热(IRR:11.952,95%CI[11.313,12.628];p<0.001)和4种性传播和血源性疾病(梅毒:IRR1.743,95%CI[1.731,1.755],p<0.001;淋病:IRR2.658,95%CI[2.635,2.682],p<0.001;HIV/AIDS:IRR2.269,95%CI[2.239,2.299],p<0.001;丙型肝炎:IRR1.540,95%CI[1.506,1.575],p<0.001),但部分被城市地区大多数人畜共患和检疫疾病发病率较低所抵消(例如,人畜共患布鲁氏菌病:IRR0.516,95%CI[0.498,0.534],p<0.001;检疫者出血热:IRR0.930,95%CI[0.881,0.981],p=0.008)。此外,中国中部地区(IRR:1.704,95%CI[1.699,1.708];p<0.001)和东北地区(IRR:1.713,95%CI[1.700,1.726];p<0.001)的整体城乡差异尤为明显。我们研究的主要局限性是,发病率是根据年平均人口数据计算的,而没有考虑人口流动性。
结论:儿童法定传染病的城乡差距很大,青少年,从我们的研究中可以看出年轻人。城市地区的负担超过农村地区的2倍以上,这种差距似乎正在扩大,特别是受结核病的影响,猩红热,感染性腹泻,还有斑疹伤寒.这些发现强调了迫切需要采取干预措施来减轻传染病和解决日益扩大的城乡差距。
BACKGROUND: An accelerated epidemiological transition, spurred by economic development and urbanization, has led to a rapid transformation of the disease spectrum. However, this transition has resulted in a divergent change in the burden of infectious diseases between urban and rural areas. The objective of our study was to evaluate the long-term urban-rural disparities in infectious diseases among children, adolescents, and youths in China, while also examining the specific diseases driving these disparities.
RESULTS: This observational study examined data on 43 notifiable infectious diseases from 8,442,956 cases from individuals aged 4 to 24 years, with 4,487,043 cases in urban areas and 3,955,913 in rural areas. The data from 2013 to 2021 were obtained from China\'s Notifiable Infectious Disease Surveillance System. The 43 infectious diseases were categorized into 7 categories: vaccine-preventable, bacterial, gastrointestinal and enterovirus, sexually transmitted and bloodborne, vectorborne, zoonotic, and quarantinable diseases. The calculation of infectious disease incidence was stratified by urban and rural areas. We used the index of incidence rate ratio (IRR), calculated by dividing the urban incidence rate by the rural incidence rate for each disease category, to assess the urban-rural disparity. During the nine-year study period, most notifiable infectious diseases in both urban and rural areas exhibited either a decreased or stable pattern. However, a significant and progressively widening urban-rural disparity in notifiable infectious diseases was observed. Children, adolescents, and youths in urban areas experienced a higher average yearly incidence compared to their rural counterparts, with rates of 439 per 100,000 compared to 211 per 100,000, respectively (IRR: 2.078, 95% CI [2.075, 2.081]; p < 0.001). From 2013 to 2021, this disparity was primarily driven by higher incidences of pertussis (IRR: 1.782, 95% CI [1.705, 1.862]; p < 0.001) and seasonal influenza (IRR: 3.213, 95% CI [3.205, 3.220]; p < 0.001) among vaccine-preventable diseases, tuberculosis (IRR: 1.011, 95% CI [1.006, 1.015]; p < 0.001), and scarlet fever (IRR: 2.942, 95% CI [2.918, 2.966]; p < 0.001) among bacterial diseases, infectious diarrhea (IRR: 1.932, 95% CI [1.924, 1.939]; p < 0.001), and hand, foot, and mouth disease (IRR: 2.501, 95% CI [2.491, 2.510]; p < 0.001) among gastrointestinal and enterovirus diseases, dengue (IRR: 11.952, 95% CI [11.313, 12.628]; p < 0.001) among vectorborne diseases, and 4 sexually transmitted and bloodborne diseases (syphilis: IRR 1.743, 95% CI [1.731, 1.755], p < 0.001; gonorrhea: IRR 2.658, 95% CI [2.635, 2.682], p < 0.001; HIV/AIDS: IRR 2.269, 95% CI [2.239, 2.299], p < 0.001; hepatitis C: IRR 1.540, 95% CI [1.506, 1.575], p < 0.001), but was partially offset by lower incidences of most zoonotic and quarantinable diseases in urban areas (for example, brucellosis among zoonotic: IRR 0.516, 95% CI [0.498, 0.534], p < 0.001; hemorrhagic fever among quarantinable: IRR 0.930, 95% CI [0.881, 0.981], p = 0.008). Additionally, the overall urban-rural disparity was particularly pronounced in the middle (IRR: 1.704, 95% CI [1.699, 1.708]; p < 0.001) and northeastern regions (IRR: 1.713, 95% CI [1.700, 1.726]; p < 0.001) of China. A primary limitation of our study is that the incidence was calculated based on annual average population data without accounting for population mobility.
CONCLUSIONS: A significant urban-rural disparity in notifiable infectious diseases among children, adolescents, and youths was evident from our study. The burden in urban areas exceeded that in rural areas by more than 2-fold, and this gap appears to be widening, particularly influenced by tuberculosis, scarlet fever, infectious diarrhea, and typhus. These findings underscore the urgent need for interventions to mitigate infectious diseases and address the growing urban-rural disparity.