基于Joinpoint回归模型的2005—2017年广东省≥60岁老年人主要传染病流行趋势变化特征分析

目的 了解2005—2017年广东省≥60岁老年人传染病流行趋势变化特征,为制定防控措施提供参考。方法 采用Joinpoint回归模型对2005—2017年广东省≥60岁老年人法定传染病进行分析,采用MSE和MAPE衡量模型拟合精确度。结果 男女合计、男性、女性发病率和死亡率拟合模型的MAPE分别为6.97%、6.72%、7.60%和3.25%、4.10%、3.63%。男、女性年发病率、死亡率均值分别为621.46/10万和253.68/10万、4.93/10万和1.13/10万;男、女比较,RR分别为2.42、4.42,且二者变化趋势均不平衡(P分别为0.000、0.004)。男女合计和男性年发病率趋势较平稳(β_合计=4.405,β_男性=0.245,均P＞0.05),女性发病率呈上升趋势(β_女性=7.895,P＜0.05),均无转折点;男女合计和男性死亡率呈“升—降—升”趋势,女性死亡率呈“升—降—降”趋势,均有2个转折点,在2009、2012年。发病率前3位病种中,肺结核发病率呈“升—降—缓升”趋势,转折点在2008、2011年;梅毒发病率呈持续较快上升趋势,转折点在2013年;腹泻病发病率趋势平缓。死亡率前3位病种中,艾滋病死亡率呈较快上升趋势,肺结核死亡率呈“缓降—降—缓升”趋势,转折点在2010、2013年;狂犬病死亡率呈“升—降—降”趋势,转折点在2009、2012年。主要病种男性发病率、死亡率均高于女性,且变化趋势均不平衡(均P＜0.05)。结论 广东省≥60岁老年人传染病发病率、死亡率趋势变化特征明显,且存在显著的病种差异和性别差异,男性发病和死亡风险持续高于女性,二者变化趋势不平衡。应采取综合协同防治措施,重点防治肺结核、梅毒和艾滋病等。

Changing characteristics of epidemic trends of main notifiable infectious diseases among the elderly aged 60 years and above in Guangdong province during 2005-2017 based on a Joinpoint regression model

Objective To understand the changing features of epidemic trends of notifiable infectious diseases among the elderly aged 60 years and over in Guangdong province in 2005-2017 so as to provide references for developing prevention and control measures. Methods A Joinpoint regression model was employed to analyze the data about notifiable infectious diseases among the elderly aged 60 years and above in Guangdong province during 2005-2017. The mean square error (MSE) and mean absolute percentage error (MAPE) were used to measure the fitting accuracy of the model. Results The MAPEs of the fitted model for the morbidity and mortality rates of both males and females were 6.97% and 3.25%, those for the incidence and mortality rates of males were 6.72% and 4.10%, and those for the incidence and mortality rates of females were 7.60% and 3.63%, respectively. The mean annual morbidity and mortality rates were 621.46/100,000 and 4.93/100,000 in males, and 253.68/100,000, and 1.13/100,000 in females. A comparison between males and females showed that the relative risk was 2.42 in males and 4.42 in females; moreover, the change trends of morbidity and mortality rates of males and females were both unbalanced(P=0.000, P=0.004). The trends of annual morbidity rates of both males and females and only males were relatively stable(β_total=4.405, β_male=0.245, both P>0.05), but the annual morbidity rate of females showed an upward trend(β_female=7.895, P<0.05), without a turning point in their change trends. The mortality rates of both males and females and only males showed an up-down-up trend, while those of females presented an up-down-down trend, with two turning points occurring in 2009 and 2012, respectively. Among the top three diseases by morbidity, the morbidity rate of tuberculosis experienced an up-down-slowly-up trend, with two turning points occurring in 2009 and 2011, respectively. The morbidity rate of syphilis showed a sustained and rapid upward trend, with a turning point occurring in 2013. The morbidity rate of infectious diarrhea remained steady. Among the top three diseases bymortality, the mortality rate of AIDS presented a rapid increase trend. The mortality rate of tuberculosis showed a slowly-down-down-slowly-up trend, with two turning points occurring in 2010 and 2013, respectively. The mortality rate of rabies showed an up-down-down trend, with two turning points occurring in 2009 and 2012, respectively. The morbidity and mortality rates of the main infectious diseases were all higher in the males than in the females, and their change trends were all unbalanced(all P<0.05). Conclusions The changing characteristics of trends of morbidity and mortality rates of infectious diseases among the elderly aged 60 years and above in Guangdong province were obvious; moreover, there existed significant differences in disease types and genders, the risk of morbidity and mortality were consistently higher in males than in females, and the changing trends of them were unbalanced. It is necessary to take comprehensive and coordinated prevention and treatment measures mainly againsttuberculosis, syphilis and AIDS.