| Background:Syphilis is one of the main infectious diseases,which ranked third among Class A and B statutory notifiable infectious diseases in China.The clinical manifestation of syphilis is very complex,which can be divided into primary,secondary,tertiary,latent and congenital syphilis.Tertiary syphilis is the late-stage syphilis which is extremely harmful.It can damage the cardiovascular,eye,or nervous systems.Studies before showed syphilis are spatially clustered,but there is a lack of research on the incidence and disease burden of neurosyphilis.At present,study on the temporal and spatial distribution of tertiary syphilis and the burden of neurosyphilis disease is one of the important tasks of syphilis research in China.Objectives:To establish a national tertiary syphilis geographic information database.Spatial auto-correlation,spatial and temporal scanning analyses are used to display the spatial evolution dynamically,in order to find out the hot spots,and provide information for disease prevention and control.In addition,Through a special survey,we calculate the disease burden of neurosyphilis including incidence,disability adjusted life years(DALY)and economic loss,which can provide evidence for the disease prevention and control and resource allocation in future.Method:Joinpoint regression model and purely-temporal analysis are used to analyze the trend of tertiary syphilis.GeoDa is employed to analyze spatial autocorrelation and spatial distribution pattern at a county-level.SaTScan is applied to perform spatial temporal scanning cluster analysis.Then ArcGIS software is utilized for displaying the analysis results(hot map,cluster areas).The disease burden of neurosyphilis(incidence,DALY,and economic burden)is calculated through Excel and SPSS.Results:During 2004-2019,the cases of tertiary syphilis reported in 31 provinces,autonomous regions and municipalities(excluding Hong Kong,Macao and Taiwan)of China was 523 in 2004,rose to 3626 in 2019.The result of Joinpoint regression analysis showed the incidence increased by 13.10%on average annual percent change(3 periods of APC:57.77%in 2004-2006;16.19%in 2006-201 1;2.34%in 201 1-2019),and purelytemporal scan cluster analysis showed that there was time aggregation from 2012 to 2019.The number of counties with reporting cases of tertiary syphilis increased from 323 to 1349.We establish the geographic information system database of tertiary syphilis cases in nearly 3000 counties and districts in China(excluding Hong Kong,Macao and Taiwan)from 2004 to 2019.Spatial autocorrelation analysis showed that the clusters were in status of high-high in all years,and the hot spots were mainly distributed in Jiangsu,Zhejiang,Fujian,Guangdong,Guangxi and Xinjiang.A total of 12 clusters were detected by spatiotemporal cluster scanning analysis(P<0.001).Among them,the first cluster area covered 437 counties and districts in 8 provinces from 2014 to 2019,mainly distributed in the eastern coastal areas;the second cluster area,which covered 291 counties and districts in six provinces,mainly distributed in the southern coastal areas,was from 2005 to 2012;the 11th cluster area,which covered 129 counties and districts in six provinces,mainly distributed in the western region,was from 2006 to 2011;The remaining cluster areas involved less provinces and counties.The spatial scanning of three time periods showed that the number and scope of counties and districts clustering increased,expanded and convergence.A total of 293 cases of neurosyphilis(61 cases in 2017,96 cases in 2018 and 136 cases in 2019)were found and indentified in medical institutions of Kunming,Xi’an,Haikou,Zhengzhou and Qingdao from 2017 to 2019,The average annual incidence rate of neurosyphilis in 5 city was 0.31(0.23-0.39)per 100000 in 2017,0.48(0.39-0.58)per 100000 in 2018,0.68(0.56-0.79)per 100000 in 2019,with an average annual increased rate of 48.11%.The DALY loss was 323.35 person-years in 2017,455.42 person-years in 2018,630.94 person-years in 2019.The DALY rate was 1.66(1.48-1.84)per 100000 in 2017,2.30(2.09-2.51)per 100000 in 2018,3.13(2.89-3.38)per 100000 in 2019.Also,we collected the data on hospitalization expenses of 255 neurosyphilis patients with clear records of hospitalization expenses in medical institutions of the 5 cities from 2017 to 2019(44 cases in 2017,89 cases in 2018 and 122 cases in 2019).The results showed that the total hospitalization cost was 4.6248 million yuan(RMB,the same below),and the average hospitalization cost was 18136.60 yuan(95%CI:15359.520913.7 yuan)each patient.By the human capital analysis,we estimated that the total indirect economic burden for 293 neurosyphilis cases was 81.6032 million yuan,and the per capita loss was 278500 yuan(95%CI:258400-298700 yuan)for each patient.The total hospitalization expenses and indirect economic losses increased year by year,but the per capita hospitalization expenses did not change significantly.Conclusions:During 2004-2019,the trend of the tertiary syphilis incidence in Chinese mainland increased substantially with a rather speed,but slowed down in recent years,and the epidemic areas were expanding.The areas of high incidence of tertiary syphilis mainly distributed in the southeastern China and northwestern China,and those areas with high incidence gradually appeared merged.The incidence of neurosyphilis was increasing significantly in 5 cities and the disease burden was considerably serious,we should pay attention to the prevention and control of neurosyphilis. |
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