湖南省2003-2011年活动性肺结核患者登记的空间分析

目的 分析湖南省活动性肺结核患者登记的空间分布规律,找出聚集区域,为进一步研究结核病危险因素及其防控策略提供理论依据。 方法 2003-2011年湖南省共登记报告活动性肺结核患者475 125例,各市州年平均登记率为80.1/10万（61.3/10万～122.8/10万）。收集整理2003-2011年登记活动性肺结核患者数和各市州年平均人口数;应用SPSS 13.0统计软件包系统聚类分析法（hierarchical cluster）进行市州年平均登记水平空间分布分析;采用SaTScan(version 9.1.1)空间统计分析软件Possion分布概率模型对湖南省2003-2011年各市州活动性肺结核患者登记进行空间、时间和时空聚集性分析;应用MAPGIS 67软件绘制地图。结果 2003-2011年湖南省活动性肺结核患者登记空间分布规律呈由西北向东南递降的趋势。空间聚集性分析共扫描出4个聚集区域,一级聚集区域为湘西州、张家界市和怀化市,实际登记患者85 065例,预计登记患者62 095例,RR=1.45（P<0.001）;二级聚集区域为娄底市,实际登记患者31 381例,预计登记患者27 043例,RR=1.17（P<0.001）;三级聚集区域为常德市,实际登记患者47 831例,预计登记患者43 366例,RR=1.11（P<0.001）;四级聚集区域为永州市,实际登记患者41 837例,预计登记患者37 656例,RR=1.12（P<0.001）。时间聚集性分析发现,2004-2006年存在活动性肺结核患者登记的聚集现象,实际登记患者162 067例,预计登记患者151 859例,RR=1.10（P=0.001）。时空聚集性分析共扫描出4个聚集区域,一级聚集区域为湘西州、张家界市和怀化市,实际登记患者41 695例,预计登记患者25 306例,RR=1.71（P<0.001）;二级聚集区域为永州市,实际登记患者9518例,预计登记患者6334例,RR=1.51（P<0.001）;三级聚集区域为娄底市,实际登记患者7223例,预计登记患者4589例,RR=1.58（P<0.001）;四级聚集区域为常德市,实际登记患者23 058例,预计登记患者19 149例,RR=1.21（P<0.001）。结论 2003-2011年湖南省活动性肺结核患者登记呈由西北向东南递降的趋势,在时间、空间和时空上均不是随机分布的,存在聚集性,最可能存在聚集的区域是湘西州、张家界市和怀化市,聚集时间为2004-2006年。

Spatial analysis on the active pulmonary tuberculosis patients registered between 2003 and 2011 in Hunan province

Objective To analyze the spatial distribution pattern of the active TB patients registered in Hunan province, and find out the gathered area, to provide theoretical basis for further study of the tuberculosis risk factors and prevention and control strategies. Methods There are a total of 475 125 cases of active TB registered between 2003 and 2011 in Hunan province, with the prefecture annual average registration rate of 80.1/100 000 (61.3/100 000-122.8/100 000). We collected the active TB registration number and average annual population in each prefecture between 2003 and 2011, analyzed the spatial distribution of average annual registration rate by SPSS 13.0 clustering analysis (hierarchical cluster), the aggregation characteristic of spatial, time and time-space distribution by SaTScan (Version 9.1.1) Possion distribution probability model, and mapping by MAPGIS 67 software. Results There was a descending trend of the spatial distribution of active TB patients registration from northwest to southeast in Hunan province between 2003 and 2011. Purely spacial analysis identified 4 clusters, the first cluster included Xiangxi, Zhangjiajie and Huaihua, and 85 065 patients were registered actually, while the expectation number of registration patients were 62 095,RR=1.45 (P<0.001), the second cluster was Loudi, 31 381 patients were registered actually, while the expectation number of registration patients were 27 043,RR=1.17 (P<0.001), the third cluster was Changde, and 47 831 patients were registered actually, while the expectation number of registration patients were 43 366,RR=1.11 (P<0.001), the fourth cluster was Yongzhou, and 41 837 patients were registered actually, while the expectation number of registration patients were 37 656,RR=1.12 (P <0.001). Purely temporal analysis identified there was a cluster between 2004 and 2006 in terms of notification on active tuberculosis patients, and 162 067 patients were registered actually, while the expectation number of registration patients were 151 859,RR=1.10 (P=0.001). The spatial analysis identified 4 clusters, the first cluster included Xiangxi, Zhangjiajie and Huaihua, and 41 695 patients were registered actually, while the expected registration number were 25 306,RR=1.71 (P<0.001), the second cluster was Yongzhou, 9518 patients were registered actually, while the expected number of 6334,RR=1.51 (P<0.001), the third was Loudi, 7223 patients were registered and the expected of 4589,RR=1.58 (P<0.001), the fourth was Changde, 23 058 patients were registered while expected of 19 149,RR=1.21 (P<0.001). Conclusion There was a descending trend of the spatial distribution of active TB patients registration from northwest to southeast in Hunan province between 2003 and 2011. The notifications are not randomly distributed in space, time and time space, and clusters did exist in Hunan. The cluster most likely existed in Xiangxi, Zhangjiajie and Huaihua, and gatheredbetween 2004 and 2006.