Changes in area distribution of newly detected leprosy cases at different control periods in Jiangxi, 2001−2020
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摘要:
目的 通过对2001—2020年江西省不同防治阶段新发麻风病例的分布特征及规律进行分析，为麻风病防治提供科学依据。 方法 以江西省各县（市、区）的空间数据库为基础，利用SaTScan 9.6软件对2001—2020年不同防治阶段新发病例按空间和时间−空间两种扫描探测模式进行统计分析，并通过ArcMap 10.5软件将分析结果可视化。 结果 2001—2020年江西省累计新发麻风病例801例，其中儿童病例占1.87%，多菌型占86.02%，2级畸残占20.35%，延迟期在12个月以内的占27.97%，发现方式以被动发现为主，占82.77%。 2级畸残比在不同防治阶段差异有统计学意义（χ2=7.032， P＜0.05）。 发现率从2001年的0.1171/10万下降至2020年的0.0173/10万，年平均发现率为（0.0915/10万±0.0387/10万）。 “十年规划”期间年平均发现率低于“十五”（Z=−3.062，P<0.01）和“十一五”期间（Z=−3.062，P<0.01）。 单纯空间扫描显示，3个时期均出现不同聚集程度的聚集区域，其中“十五”期间出现了1个一类和2个二类聚集区域，“十一五”期间出现1个二类聚集区域，“十年规划”期间分化为3个二类聚集区域，聚集范围呈现扩大化。 时间−空间扫描显示，在2001—2020年期间共探测到2个一类聚集区域和1个二类聚集区域，主要位于江西省南部偏西，聚集年份集中在2004—2005年、2009—2010年、 2011—2015年。 结论 2001—2020年江西省麻风病发现率逐年下降，在空间分布上聚集性程度逐年下降，但是聚集范围逐年扩大。 今后的防治工作不仅要针对聚集区域，同时要重视因聚集范围不断扩大而覆盖的区域。 Abstract:Objective To analyze the spatiotemporal distribution of newly leprosy cases in different control periods in Jiangxi province from 2001 to 2020 and provide evidence for prevention and control of leprosy. Methods Based on the spatial database of counties (districts) in Jiangxi, the statistical analysis on the newly detected leprosy cases reported in Jiangxi at different control periods from 2001 to 2020 was carried out by using SaTScan spatiotemporal scanning statistical software based on two scanning detection modes of space and time-space, and the analysis results were visualized by ArcMap. Results From 2001 to 2020, a total of 801 newly detected leprosy cases were reported in Jiangxi. Among these cases, 1.87% were children under 15 years, 86.02% were multibacillary cases, and 20.35% suffered from grade 2 disability, 27.97% had delayed treatment for ≤12 months and most cases (82.77%) were detected passively. There was significant difference in grade 2 disability ratio in different control periods (χ2=7.032, P＜0.05). The detection rate of leprosy case decreased from 0.1171/100 000 in 2001 to 0.0173/100 000 in 2020, with an average detection rate of (0.0915±0.0387) per 100 000. The average detection rate in the ten-year leprosy risk elimination period was significantly lower than that in the 10th Five-Year Plan period (Z=−3.062, P<0.01) and the 11th Five-Year Plan period (Z=−3.062, P<0.01). The simple spatial scanning showed that there were clustering areas with different clustering degrees in the three periods. There was one category I clustering areas and two category Ⅱ clustering areas in the 10th Five-Year Plan period, one category Ⅱ clustering area in the 11th Five-Year Plan period, and two category Ⅱ clustering areas in the ten-year leprosy risk elimination period, showing an expansion of clustering areas. The spatiotemporal scanning showed that two clustering areas of category Ⅰ and one clustering area of category Ⅱ were detected during 2001−2020, which were all distributed in southwestern Jiangxi during 2004−2005, 2009−2010 and 2011−2015. Conclusion The case detection rate of leprosy decreased and the degree of spatial clustering became lower year by year in Jiangxi, but the clustering areas expanded. Leprosy prevention and control should be strengthened not only in the clustering areas, but also in the newly affected areas in the future. -
Key words:
- Leprosy /
- Newly detected leprosy case /
- Clustering /
- Spatiotemporal analysis
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图 1 2001－2020年江西省麻风病发现率趋势
Figure 1. Trend in detection rate of leprosy in Jiangxi, 2001−2020
图 2 2001－2020年江西省不同防治阶段麻风病新发病例空间聚集性分布
注：A. “十五”期间一类5个县（上犹县、南康区、崇义县、遂川县、大余县）；第1个二类9个县（章贡区、赣县区、万安县、井冈山市、信丰县、泰和县、于都县、永新县、兴国县）；第2个二类5个县（于都县、赣县区、瑞金市、会昌县、兴国县）；B. “十一五”期间二类25个县（定南县、龙南县、信丰县、安远县、寻乌县、全南县、大余县、会昌县、章贡区、南康区、赣县区、于都县、崇义县、上犹县、瑞金市、兴国县、万安县、遂川县、石城县、泰和县、宁都县、井冈山市、吉州区、广昌县、永新县）；C. “十年规划”期间第1个二类4个县（信丰县、万安县、安远县、泰和县）；第2个二类7个县（上犹县、南康区、崇义县、遂川县、大余县、章贡区、赣县区）；第3个二类8个县（石城县、宁都县、广昌县、瑞金市、南丰县、兴国县、于都县、会昌县）
Figure 2. Spatial clustering of newly detected leprosy cases in different control periods in Jiangxi, 2001−2020
图 3 2001－2020年江西省不同防治阶段新发麻风病例时间–空间聚集性分布
注：A. “十五”期间一类4个县（上犹县、南康区、崇义县、遂川县）；B. “十一五”期间一类3个县（遂川县、井冈山市、上犹县）；C. “十年规划”期间二类16个县（上犹县、南康区、崇义县、遂川县、大余县、章贡区、赣县区、万安县、井冈山市、信丰县、泰和县、于都县、永新县、兴国县、全南县、安远县）
Figure 3. Spatiotemporal clustering of newly detected leprosy cases in different control periods in Jiangxi, 2001−2020
表 1 不同防治阶段新发麻风病例特征分析［例（%）］
Table 1. Epidemiological characteristics of newly detected leprosy cases in different control periods
变量 “十五”期间［例（%）］ “十一五”期间［例（%）］ “十年规划”期间［例（%）］ χ2值 P值 新发病例数 271 264 266 性别 1.121 0.571 男性 202（74.54） 190（71.97） 202（75.94） 女性 69（25.46） 74（28.03） 64（24.06） 年龄 0.462 0.794 非儿童 267（98.52） 258（97.73） 261（98.12） 儿童 4 （1.48） 6 （2.27） 5 （1.88） 型别 5.675 0.059 多菌型 242（89.30） 217（82.20） 230（86.47） 少菌型 29（10.30） 47（17.80） 36（13.53） 2级畸残 7.032 0.03 有 41（15.13） 59（22.35） 63（23.68） 无 230（84.87） 205（77.65） 203（76.32） 延迟期（月） 1.013 0.603 ≤12 80（29.52） 68（25.76） 76（28.57） ＞12 191（70.48） 196（74.24） 190（71.43） 发现方式 2.252 0.324 主动发现 41（15.15） 44（16.67） 53（19.92） 被动发现 230（84.87） 220（83.33） 213（80.08） 
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