中国手足口病时空分异特征及影响因素

健康中国战略是中国新时期的重大战略之一,手足口病作为全球关注的公共卫生问题,已成为中国影响范围较为广泛和普遍的典型传染性疾病,尤其对婴幼儿健康造成巨大威胁。本文构建健康地理学视角下的传染病研究理论框架,采用集中度和空间分析方法解析中国2008—2017年手足口病发病时空分异特征和变化规律,对18个影响其发病的风险因子进行空间相关和地理探测,揭示手足口病地理分异的主要影响因素和作用机理。结果表明：① 健康地理学视角下的传染病研究理论框架由传染病发病的基本环节、影响因素和分布扩散状态3个子系统构成,各子系统之间及子系统内部相互影响相互作用。② 2008—2017年中国手足口病发病率呈现波动上升、两年为一周期且偶数年份高于奇数年份的发病规律,春末夏初及秋末冬初为发病高峰。③ 2008—2010年手足口病发病率未体现明显的空间集聚特征;2011—2017年发病率存在较强的空间自相关性,热点地区主要集中在广东、广西、海南等地区,且呈现自北向南、自小而分散向大而集中的演变趋势;发病典型地区可以总结为气候湿热区、经济落后且医疗水平低的地区和易集聚感染的人口密集区3种。④ 有12项因素通过了相关分析和地理探测的显著性检验,与手足口病发病率体现正向作用的因素解释力从大到小依次为“气温>年降水量>湿度>气压>人口密度>路网密度>人均GDP”,负向相关关系作用大小依次为“日照时数>风速>AQI指数>海拔>千人床位数”,气温和降水量与其他因子的交互作用最为明显。本文为健康地理学、手足口病病理学、流行病学的相关研究提供实证检验基础,为服务健康中国战略和流行病预防与控制提供重要科学支撑和政策参考。

Spatio-temporal differentiation characteristics and influencing factors of hand,foot,and mouth disease in China

The Healthy China initiative is one of the important strategies in the new period of China. Hand, foot, and mouth disease (HFMD) is a global health threaten. It is a typical infectious disease with a wide and universal impact in China, especially to infants. This paper develops a theoretical framework for the study of infectious diseases from the health geography perspective. The framework used concentration and spatial analysis methods to analyze the spatio-temporal differentiation and evolution patterns of HFMD incidence in China from 2008 to 2017. Using spatial correlation analysis and geographic detection of 18 risk factors for the incidence of HFMD, we identified the main influencing factors and revealed the mechanism of the geographic distribution of HFMD. The results show that: (1) the theoretical framework of infectious disease research from the perspective of health geography includes three subsystems: the basic link of infectious disease, influencing factors, and the distribution and diffusion state of the infectious disease with mutual interaction and impact between and within the three subsystems. (2) From 2008 to 2017, the incidence rate of HFMD in China showed a fluctuating increase, with a two-year cycle. In addition, the incidence in the even years was higher than that in the odd years. The peaks of incidence are observed in late spring, early summer, late autumn, and early winter. (3) The incidence rate of HFMD from 2008 to 2010 did not reflect obvious characteristics of the spatial agglomeration. However, the incidence rate had a strong spatial autocorrelation from 2011 to 2017. Hotspots were mainly distributed in southern humid areas such as Guangdong, Guangxi, and Hainan. Moreover, the spots were evolving from north to south, and changing from small and scattered to large and concentrated spots. HFMD mainly occurred in three typical areas, namely, areas with hot and humid climates, economically underdeveloped areas with poor medical resources, and densely populated areas prone to clustered infections. (4) Twelve factors have passed the test of significance of correlation analysis and geographical detection. The explanatory power of the factors that positively affect the incidence rate are sorted as follows: AT > AP > RH > BP > PD > RND > PCG; factors that have negative correlation are sorted as follows: SD > WS > AQI > DEM > HBP. The interaction between AT and AP and other factors is the most obvious. This study provides an empirical basis for research into HFMD's health geography, pathology, and epidemiology, and important scientific support and policy reference for serving the strategy of Healthy China and epidemic control and prevention.