阿坝县大骨节病健康寿命损失的时空集聚特征及影响机制

以四川省阿坝县为例，采用伤残所致健康寿命损失年（Years lived with disability, YLD）指标，分别测算不同年龄组、性别和病情程度的大骨节病健康寿命损失，并利用空间自相关分析、趋势拟合、地理探测器等方法，探讨其在县域乡镇级尺度的时空集聚特征和影响机制。结果表明：阿坝县总YLD为1783.58人年，YLD率为31.25人年/1000人，高年龄组和女性YLD率较高，II度大骨节病所致YLDs占比最高（40.8%），患病率与健康寿命损失之间未呈一致趋势。空间上YLD率呈北低南高的集聚特征，土壤类型是影响其分布最主要的环境因子，解释了64.7%的健康寿命损失空间分异，社会因素中土地利用类型的解释力最大（62.0%），气候与地形土壤、人口质量与人口结构交互产生的因子解释力增加更为明显。时间上YLDs集中分布于20世纪60~70年代，并呈稳步下降态势。大骨节病健康寿命损失的时空集聚特征受自然、社会、政策等因素的综合影响，空间上自然因素起主导作用，而时间上则主要受病区社会环境变化的影响。

Spatio-temporal Agglomeration and Influencing Mechanism of Healthy Life Loss from Kashin-Beck Disease in Aba County

Kashin-Beck disease (KBD) is one of the key endemic diseases in China’s Health Poverty Alleviation Project. This study attempts to assess the healthy life loss caused by KBD in Aba County, Sichuan Province by using the metric of years lived with disability (YLD). The age-sex specific YLDs and YLD rate among KBD grades were measured, respectively. The spatial and temporal agglomeration characteristics at the township scale and the influencing mechanism of YLDs and YLD rate were analyzed by the methods of spatial autocorrelation, trend fitting and geo-detector. The results showed that the total healthy life loss from KBD in Aba County was estimated at 1783.58 YLDs (31.25 YLD per 1000 population). YLD rates for elderly group and females were relatively high. Among different KBD grades, KBD of grade II contributed most to the total YLDs (40.8%). There was no consistent trend between the prevalence rate and the YLD rate of KBD. The YLD rate in Aba County showed a spatial agglomeration characteristic, with low values in the north and high values in the south. The soil type was the most important environmental influencing factor, accounting for 78.7% of the spatial variation of the YLD rate. The land use type was the most influential social factor, which accounted for 62.0% of its spatial variation. The interactions between climate and terrain, soil, as well as population quality and population structure presented nonlinear enhancement, significantly increasing the explanatory power of single factors. The YLDs showed a steady decline trend over time and concentrated in the 1960s and 1970s. The spatial and temporal agglomeration of the healthy life loss from KBD were collectively affected by natural, social and policy factors. The natural factors played a dominant role in space, while the social environment mainly played roles in time.