2004―2019年宁夏地区肺结核时空分布差异的影响因素研究

  目的  探讨宁夏回族自治区(简称宁夏)肺结核时空分布差异的可能影响因素，可为深入认识肺结核的传播机制提供参考依据。  方法  根据宁夏2004―2019年肺结核标准化发病比(standardized morbidity ratio, SMR)数据，运用空间杜宾模型(spatial Dubin model，SDM)分析宁夏肺结核发病时空分布差异的可能影响因素。  结果  SDM显示日照时数(β=0.000 336 4，P=0.021)、卫生机构数(β=0.003 058 8，P < 0.001)和人均国内生产总值(gross domestic product, GDP)(δ=0.000 013 3，P < 0.001)与宁夏肺结核SMR呈正相关，而降水量(δ=-0.000 919 9，P=0.028)和卫生机构人员数(β=-0.000 109 2，P=0.005；δ=-0.000 148 0，P=0.034)与宁夏肺结核SMR呈负相关。日照时数、卫生机构数和卫生机构人员数表现为直接效应，降水量、人均GDP和卫生机构人员数表现为间接效应，其中人均GDP具有正向的空间溢出效应，而降水量和卫生机构人员数具有负向的空间溢出效应。  结论  宁夏肺结核发病的空间聚集性可能与经济发展水平(人口流动性)、干旱日照长的气候环境和医疗卫生资源配置等因素有关，建议相关部门调整相应的政策以提升宁夏不同县(区)间的肺结核防制能力。

Study on influencing factors of spatial and temporal distribution difference of tuberculosis in Ningxia from 2004-2019

  Objective  The purpose of this study was to explore the potential influencing factors of the Spatio-temporal distribution difference of tuberculosis in Ningxia Hui Autonomous Region (referred to as "Ningxia"), which may provide a reference for an in-depth understanding of the transmission mechanism of tuberculosis.  Methods  Based on the standardized morbidity ratio (SMR) data of tuberculosis in Ningxia from 2004 to 2019, the spatial Dubin model (SDM) was established to analyze the potential influencing factors of the Spatio-temporal distribution difference of tuberculosis in Ningxia.  Results  The SDM showed that the sunshine hours (β=0.000 336 4, P=0.021), the number of health institutions (β=0.003 058 8, P < 0.001) and per capita gross domestic product (GDP) (δ=0.000 013 3, P < 0.001) were positively correlated with SMR, while precipitation (δ= -0.000 919 9, P=0.028) and the number of health institution personnel (β= -0.000 109 2, P=0.005; δ= -0.000 148 0, P=0.034) were negatively correlated with SMR. The sunshine hours, the number of health institutions and the number of health institution personnel showed the direct effects. Precipitation, the per capita GDP and the number of health institution personnel dispalyed the indirect effects, where per capita GDP had a positive spatial spillover effect, and precipitation and the number of health institution personnel has a negative spatial spillover effect.  Conclusions  The study shows that the Spatio-temporal cluster of tuberculosis in Ningxia may be related to the economic development level (population mobility), the climate environment with drought and long sunshine, and the allocation of medical and health resources. Thus, it is suggested that relevant departments adjusted the corresponding policies to improve the tuberculosis prevention and control ability among different counties (districts) in Ningxia.