2004-2018年中国大陆地区伤寒副伤寒发病变化趋势的流行特征

目的  探索2004-2018年中国大陆地区伤寒副伤寒发病的流行特征，为做好伤寒副伤寒预防控制工作提供依据。方法  2004-2018年伤寒副伤寒病例数和死亡数收集于中国公共卫生科学数据中心的共享数据以及国家统计局的人口学资料。利用Excel 2019软件创建伤寒副伤寒发病数据库。使用Joinpoint 4.9.0.0软件进行的Joinpoint回归模型分析，估计2004-2018年全国各个年龄组、各个省份及不同分区年伤寒副伤寒发病率的平均年度变化百分比(average annual percent change，AAPC)，分析伤寒副伤寒发病的变化趋势特征。结果  2004年1月-2018年12月全国总共报告伤寒副伤寒18 195例(年平均发病率为1.358 6/10万)，病死率为0.326 1/1 000。2004-2018年发病率和死亡率呈下降趋势(均P＜0.05)，其中2008-2018年伤寒副伤寒发病率年度变化百分比(annual percent of changes，APC)(APC：-24.96%，P＜0.001)较2004-2008年(APC：-4.10%，P=0.003)的下降速度呈放缓态势，21个省份发病率呈下降趋势(均P＜0.05)和10个省份呈平稳趋势，七大分区发病率均呈下降变化趋势，西南地区年平均发病率下降幅度最大，华南地区的下降幅度最小。伤寒副伤寒在40岁以下高发，发病率最高的为0~＜10岁组(1.906/10万)。伤寒副伤寒年平均病死率在≥80岁年龄组最高(1.363 6/1 000)，30岁以上者的病死率随年龄增加呈现较迅速的上升变化。结论  2004-2018年全国伤寒副伤寒年报告发病率趋势均呈平稳下降状态，各省份仍有不同程度的流行与散发，发病率的降幅不同。0~＜10岁组发病率高，≥80岁组病死率高。伤寒副伤寒的预防控制仍应高度重视。

Epidemic characteristics of the changing trend of typhoid and paratyphoid in Chinese Mainland from 2004 to 2018

Objective This study aims to investigate the epidemiological characteristics of typhoid and Paratyphoid fever in China from 2004 to 2018, providing evidence for the prevention and control of these diseases. Methods Data on typhoid and paratyphoid cases and deaths from 2004 to 2018 were collected from the shared data Center of China Public Health Science and demographic data of the National Bureau of Statistics. Excel 2019 software was used to create a database of typhoid and paratyphoid fever. The joinpoint regression model was used to estimate the average annual percent change (AAPC) of typhoid and paratyphoid fever incidence in different age groups, provinces, and districts in China from 2004 to 2018. The changing trend characteristics of typhoid and paratyphoid fever incidence were then analyzed. Results From January 2004 to December 2018, a total of 18 195 cases of typhoid and paratyphoid fever were reported nationwide (the annual average incidence rate was 1.358 6/100 000), and the mortality rate was 0.326 1/1 000. From 2004 to 2018, both the incidence and mortality rate of typhoid and paratyphoid fever showed a downward trend (all P < 0.05). The incidence of typhoid and Paratyphoid fever from 2008 to 2018 showed an accelerated decline (APC: -24.96%, P < 0.001) compared to the period from 2004-2018 (APC: -4.10%, P=0.003). The incidence rates in 21 provinces showed a significant downward trend (all P < 0.05), 10 provinces showed a steady trend, and the incidence rate of the seven regions showed a downward trend. The annual average incidence rate in the seven regions showed a downward trend. The annual average incidence rate decreased the most in southwest China, and the least in South. The incidence of typhoid and paratyphoid fever was high in people under the 39-year-old group, and the highest incidence rate was in the 0- < 10-year-old group (1.906/100 000). The annual average mortality of typhoid and paratyphoid fever was the highest in the age group≥80 years old (1.363 6 / 1 000), and the mortality of patients over 30 years old showed a rapid increase with age. Conclusions From 2004 to 2018, the annual reported incidence of typhoid and paratyphoid fever in China shows a steady decline. There were still different degrees of epidemics and sporadic cases in different provinces, and the incidence decline was different. The incidence rate is higher in the 0- < 10-year-old group, and the mortality is higher in the≥80-year-old group. The situation of prevention and control of typhoid and paratyphoid fever should still be paid great attention to.