| Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis.People are general susceptibility to Mycobacterium tuberculosis.In the history,tuberculosis had a "white plague" said.According to the WHO report,the global cases of new TB patients were 10,400 thousand in 2015,and 1,400 thousand people died of tuberculosis.The rate of decline in tuberculosis incidence was only about 1.5%from 2014 to 2015.The tuberculosis reporting and management systems are still not perfect in some developing countries.So the scale of TB epidemic is still greater than the previously estimated.Tuberculosis remains a public health problem that requires the global attention.Tuberculosis prevention and control in China.Governments at all levels under the leadership of the central government,have implemented three Ten-year-plan and one Five-year-plan on National TB control programs in the past years for the prevention and control of tuberculosis.China’s high incidence of tuberculosis has been effectively curbed.Since 2015,the number of new TB patients in China has dropped from the second in the world to the third.However,China is still one of the 22 high burden countries in the world.China is well known in the lists of countries with high burden of TB,high burden of multi drug resistant TB and high burden of TB/HIV.The number of TB patients in China accounts for about 10%of the global TB.Despite the decline in the prevalence of active pulmonary tuberculosis,but the estimated number of active TB patients in 2010 is increasing compared to the year of 2000,because of the growth of the large number of population in the country.4,990 thousand cases of active pulmonary tuberculosis were reported in the survey of tuberculosis epidemiology in 2010.The huge number of active tuberculosis patients indicates that the burden of TB in China is still heavy.As a developing country,the prevention and control of tuberculosis in China is still a major public health problem.Although from the national point of view,the outbreak of tuberculosis in Shandong province belongs to the eastern provinces of high economic developments is low.However,since 2005,the incidence of tuberculosis in Shandong province has increased significantly compared with that in 1997,and the falling rates of the incidence of tuberculosis in recent years were slow.Therefore,it is necessary to analyze the incidence of TB in Shandong province and below the provincial level,in order to find out the characteristics andinfluencing factors of tuberculosis,and to take some measures for preventing and controlling tuberculosis.With the development of spatial epidemiology,the application of geographic information system tools can be used to study the incidence and epidemic of tuberculosis.The results show that tuberculosis has spatial auto-correlation andspatial heterogeneity.With the methods of epidemiology and statistics analysis,a regional distribution of TB status and trends,temporal and spatial distribution characteristics and its influencing factors can be better revealed.But so far,there has not been a spatial analysis of the incidence of tuberculosis in Yantai city,in order to find statistically significant results and the accumulation of tuberculosis.In the study,case data of tuberculosis patients in Yantai City Shandong Province are collected from 2009 to 2014.Descriptive epidemiological analysis was performed by calculating the incidence of reported disease.Using Arc GIS,GeoDa and SaTscan spatial statistical analysis software,carry on spatial auto-correlation analysis and spatial scanning analysis.Explore the factors influencing the occurrence and spread of tuberculosis,to provide the prevention and control strategies for TB control in Yantai,and to provide suggestions and references for the government to formulate appropriate TB control policies.Results1.(1)A total of 15338 cases of tuberculosis registered in Yantai City,Shandong Province,from 2009 to 2014.The average annual incidence is 36.85 per 100 000 in six years.(2)There are reported TB cases every year,from March to June as the peak of the report,the number of reported highest incidence is April.(3)There was significant difference between male and female patients from 2009 to 2014.Chi square values were 523.17,448.12,450.34,431.59,410.18 and 380.16,respectively,and P values were less than 0.01.The risk of male was 2.51,2.37,2.48,2.46,2.53,and 2.51 times respectively,compared with the female.TB patients are mainly 15-34 years old age group of young people,accounted for 39.94%,and 45-64 years old age group,accounted for 29.98%.(4)The number of the top five ranked tuberculosis occupation were farmers in 9460 cases(61.68%),2151 cases of domestic household unemployed workers(14.02%),1097 cases(7.15%),861 students(5.61%)and 763(4.97%)cases of migrant workers.(5)The incidence of tuberculosis in Laiyang District and Penglai District is 1.25 times higher than that of the average.The incidence of tuberculosis in Laishan District,Economic-Technological Development District,Fushan District and Laizhou District is 0.75 times lower than that of the average.2.(1)The annual report of tuberculosis incidence of global spatial auto-correlation coefficients of Moran’s I were-0.2295(P=0.1950),-0.3715(P=0.0300),-0.1998(P=0.2370),-0.1654(P=0.3290),0.0217(P-0.2950)and 0.0994(P=0.1590),from 2009 to 2014,in Yantai city.Local spatial auto correlation analysis showed that there was spatial heterogeneity in the tuberculosis reporting in Yantai,and the average annual incidence rate of tuberculosis in Yantai was statistically significant.The regions were "high-low" in Zhifu District,and the "low-high" region was Qixia city.(2)Tuberculosis reported in Yantai city during 2009-2014 incidence by analysis of simple spatial scanning showed 5 high incidence areas,named Laiyang city(LLR=226.63,P<0.0001,RR=1.59),Penglai city(LLR=39.01,P<0.0002,RR=1.31),Zhifu District(LLR=21.67,P<0.0001,RR=1.17),Muping District(LLR=19.90,P<0.0001,RR=1.21)and Zhaoyuan city(LLR=0.40,P=0.9940,RR=1.03).Conclusions1.The peak of the TB report is from March to June each year in Yantai city.Tuberculosis in Yantai is dominated by male patients.The risk of tuberculosis was 2.48 times higher than that of female.15-34 years of age group of patients is the largest number of TB cases.The incidence of tuberculosis in Yantai city by farmers,domestic household unemployed,workers,students and migrant workers were the main,total accounting for 93.43%.The TB patients were mainly local,but the incidence of tuberculosis in the field of population is higher than the local.2.The top two Districts of the incidence of tuberculosis of excess hazard ratio are Laiyang City and Penglai District.3.The incidence of TB reporting in Yantai is spatially heterogeneous.The incidence of tuberculosis reported in Qixia City is lower than the surrounding cities including Laiyang City,Haiyang City and Muping District.The incidence of tuberculosis reported in Zhifu District is higher than the surrounding districts including Laishan District,Fushan District and Economic-Technological Development District.4.Laiyang city,Penglai city,Zhifu District and Muping District are the main cluster areas of tuberculosis in Yantai city. |
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