基于不同年龄-时期-队列模型对2009—2021年全国0～9岁儿童2009-2021年手足口病病死率的研究

刘天; 向泉; 秦周; 阮德欣; 谢聪; 黄淑琼; 杨雯雯; 赵婧

doi:10.3784/jbjc.202501140042

基于不同年龄-时期-队列模型对2009—2021年全国0～9岁儿童2009-2021年手足口病病死率的研究

Case fatality rate of hand foot and mouth disease in children aged 0–9 years in China, 2009 - 2021, a study based on different age–period–cohort models

摘要

摘要:
目的尝试利用多种年龄-时期-队列（APC）模型分析全国0~9岁儿童手足口病病死率的年龄、时期和出生队列趋势。
方法收集2009—2021年全国0~9岁手足口病发病及死亡数据，采用基础APC模型、基于简约参数的APC模型和贝叶斯APC模型探讨全国手足口病病死率的年龄、时期和出生队列趋势。以4岁、2015年、2010年作为年龄、时期、队列参照，计算相对危险度（RR）及95%置信区间（CI）。年度变化百分比（AAPC）、平均单元变化百分比（AUPC）及95%CI用于判定是否存在趋势变化。
结果 2009—2021年全国共报告手足口病23 783 967例，死亡3 565例，病死率14.99/10万。基础APC模型分析显示，2009—2021年手足口病病死率呈下降趋势（AAPC=−31.30%，95%CI: −37.55%～−25.06%）；手足口病年龄别病死率趋势无统计学意义（χ²=9.738，P=0.284）；出生队列手足口病病死风险存在下降趋势（χ²=53.230，P<0.001）。基于简约参数的APC模型分析显示，水平及年龄斜率参数有统计学意义（P<0.05），部分时期因子参数有统计学意义（P<0.05），队列斜率及队列因子参数均无统计学意义（P>0.05）。贝叶斯APC模型分析显示，随着年龄增加手足口病病死风险呈下降趋势（AUPC=−74.81%，95%CI: −79.35%～−70.28%）；随着时期增加手足口病病死风险呈下降趋势（AUPC=−53.26%，95%CI: −67.21%～−39.32%）；随着出生年份增加手足口病病死风险无明显趋势变化（AUPC=−0.02%，95%CI: −0.16%～0.11%）。
结论 2009—2021年全国手足口病病死率存在明显年龄、时期趋势，随着年龄（时期）增加，病死率下降；出生队列效应未观察到。

Abstract:
Objective To explore the age, period, and birth cohort specific trends of the case fatality rate of hand, foot, and mouth disease (HFMD) case fatality rate in(CFR) among children aged 0–9 years in China based using different various age-period-cohort (APC) models.
Method The incidence and deathD data ofn HFMD cases and deaths inamong children aged 0–9 years in China from 2009 to 2021 were collected. An basic APC model, a simplified parameter-based APC model, and a Bayesian APC model were used to analyzeexamine the trends in the case fatality rate of HFMDCFR nationwide. Age, period, and cohort references were set to 4 years, 2015, and 2010, respectively, and relative risks (RR) andwith 95% confidence intervals (95%CI) were calculated. The annual percent change (AAPC), the average unit percent change (AUPC), and the 95% confidence interval (95%CI) were used to evalaute the changedetermine whether a trends change existedAverage annual percent change (AAPC), average unit percent change (AUPC), and their 95%CI were used to determine the presence of trends.

Result FromBetween 2009 toand 2021, a total of 23,783,967 HFMD cases and 3,565 deaths of HFMD were reported in China, with the case fatality ratea CFR wasof 14.99 per 100,000. The Aanalysis using the basic APC model revealed a declining trend in the case fatality rateCFR (AAPC = −31.30%, 95% CI: −37.55% -to −25.06%). The difference in Aage-specific case fatality rateCFR trends were not statistically significant (χ²=9.738, P=0.284), while the birth cohort specific risk for HFMD death showed a decreasing risk trendof HFMD fatality (χ²=53.230, P=0.000). In the simplified parameter-based APC model analysis, the differences in level and age slope parameters were statistically significant (P<0.005), same foras were some period parameters (P<0.05). However, neither the birth cohort slope nor the birth cohort related factor parameters were showed significant differences (P>0.058). The Bayesian APC model analysis indicated a declining case fatality rate CFR with increasing age (AUPC = −74.81%, 95% CI: −79.35% -to −70.28%) and period (AUPC = −53.26%, 95% CI: −67.21% to −39.32%), but no notable trends were found in different in relation to birth cohorts (AUPC = −0.02%, 95% CI: −0.16% -to 0.11%).
Conclusion The case fatality rateCFR of HFMD in China showed significant age and period specific trends, decreasing with increasing age and period, while no birth cohort specific trendeffect was observed.

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