Epidemic Trend Prediction Of Tuberculosis And Influencing Factors Of Delay In Medical Treatment In Panyu District,Guangzhou From 2005 To 2020

ObjectiveTuberculosis is one of the top ten causes of death in the world and is a chronic infectious disease that seriously endangers public health.This article explores the 2005-2020,Guangzhou Panyu district of the whole population,school tuberculosis epidemic characteristics of tuberculosis incidence forecast model is set up,analysis the situation and influencing factors of tuberculosis patient delay,investigating a school tuberculosis outbreak of clustering,in order to understand Panyu district tuberculosis epidemic characteristics,find the problems existing in the tuberculosis prevention and control work,to provide scientific basis and reference for the precise prevention and control of tuberculosis.Methods1.The Cochran-Armitage trend test,Joinpoint regression and seasonal index were used to analyze the epidemiological characteristics of tuberculosis incidence in Panyu district of Guangzhou from 2005 to 2020,and the annual percentage change（APC）and average annual percentage change（AAPC）were calculated to compare the changing trends.To describe the epidemiological characteristics of tuberculosis in student population from 2016 to 2020.2.The SARIMA model was used to fit the monthly incidence data of tuberculosis,and the combined prediction model of SARIMA and support vector machine（SARIMA-SVM）was constructed.The applicability and prediction effect of SARIMA model and SARIMA-SVM model in the prediction of tuberculosis incidence were compared.To explore the best model for predicting the incidence of tuberculosis.3.The behavioral characteristics and trends of delayed treatment of tuberculosis patients in the whole population and student population in Panyu District were analyzed,and the influencing factors of delayed treatment of tuberculosis patients were analyzed by unconditional multivariate Logistic regression model.4.Through the field epidemiological investigation,the causes and transmission chains of the tuberculosis cluster epidemic in a school were explored,the main problems existing in tuberculosis prevention and control in the school were found out and the intervention countermeasures were proposed.Results1.Tripartite distribution of pulmonary tuberculosis in Panyu districtA total of 21639 cases of tuberculosis were reported in Panyu District of Guangzhou from 2005 to 2020,and the annual incidence decreased from125.67/100,000 to 36.38/100,000.The overall incidence showed a decreasing trend（AAPC=-5.86%,P<0.001）,with an annual decline rate of 7.45%.The standard morbidity of male patients（100.51/100,000）and female patients（51.28/100,000）showed a linear downward trend,and the AAPC value was-4.37%（P<0.001）and-3.84%（P<0.001）,respectively.There was a decreasing trend in 15-44 age group（P<0.05）;There was an increasing trend in 45-54,65-74 and 80-84 age groups in recent years（P<0.05）.The standard incidence of tuberculosis in local household registration decreased by 4.7%per year on average（P<0.001）,and the incidence ratio showed a linear increasing trend（Z=2.110,P=0.035）.The standard incidence of pulmonary tuberculosis in floating population decreased by 6.6%per year on average（P<0.001）.In the occupational distribution,the number of tuberculosis cases in middle school students ranked the fourth,and its composition ratio showed a linear increase（AAPC=5.5%,P=0.002）.In terms of time trend,the monthly incidence of pulmonary tuberculosis showed obvious seasonal characteristics,with high incidence from April to September,highest in April and August,and low incidence in winter.The top 4 towns and streets with cumulative incidence were Shatou Street（188.6/100,000）,Shiqi Town（164.5/100,000）,Dashi Street（144.9/100,000）and Shiqiao Street（95.4/100,000）.From2016 to 2020,a total of 406 cases of tuberculosis were reported among students in Panyu District of Guangzhou,with the reported incidence decreasing from16.82/100,000 to 10.67/100,000,with an annual decline rate of 8.70%.Male to female ratio 1.59∶1;College students（64.7%）and high school students（19.3%）accounted for the largest proportion.2.Tuberculosis prediction modelThe optimal SARIMA（2,0,1）（0,1）₁₂ model was established.The mean absolute percentage error of SARIMA model and SARIMA-SVM combined model in predicting the monthly incidence of tuberculosis in Panyu District of Guangzhou in 2020 was82.50%and 78.11%,respectively.The root mean square error was 2.45 and 2.09,respectively.The combined model of SARIMA-SVM was more accurate.By using the established SARIMA-SVM model to predict the trend of tuberculosis incidence,the prevalence of tuberculosis in Panyu District showed a declining trend.3.The incidence and influencing factors of delayed treatment for tuberculosisFrom 2016 to 2020,M（Q1,Q3）of student tuberculosis patients in Panyu District saw a doctor for 14（3,28）days,and the delay rate was 39.66%（161/406）.From 2005to 2020,M（Q1,Q3）of visits to the doctor for tuberculosis patients in Panyu District of Guangzhou was 15（3,43）days,and the delay rate was 51.1%（11065/21639）,showing an overall increasing trend(χ²_trend=24.909,P<0.001).The delay rate of female patients was higher than that of male patients（P<0.05）.The delay rate of treatment in different age groups was different（P<0.05）.The delay rate of local household registration was higher than that of floating population（P<0.05）.Gender stratification:male（APC=1.9%,P=0.014）and female（APC=3.9%,P=0.023）showed an increasing trend in recent years.Age group stratification:<24 years old（APC=3.1%,P=0.017）,24-29years old（APC=2.1%,P=0.009）pulmonary tuberculosis patients’delay rate showed an increasing trend in recent years;The delay rate of tuberculosis patients aged 40-54 years old（APC=-6.3%,P=0.045）and≥55 years old（APC=-3.1%,P=0.030）showed a decreasing trend in recent years.Stratification of household registration:The delay rate of patients from floating population showed an increasing trend from 2005 to 2011（APC=3.8%,P=0.010）.Logistic regression showed that the rate of delay in treatment was higher in women（OR=1.253,95%CI:1.179-1.332）,and the rate of delay in treatment increased with age.Compared with the<24 years old group,the rate of delay in treatment in the 30-39 years old group（OR=1.224,95%CI:1.179-1.332）1.119-1.339),40-54 years old group（OR=1.663,95%CI:1.511-1.830）and≥55 years old group（OR=1.648,95%CI:1.481-1.834）.Those engaged in production of agriculture,forestry,animal husbandry,fishing and water conservation（OR=1.544,95%CI:1.326-1.799）,operators of production and transportation equipment and related personnel（OR=1.255,95%CI:1.095-1.440）had higher delay rate of seeing a doctor for tuberculosis patients.Patients were found to have a high rate of delay in medical treatment through treatment for symptoms（OR=3.126,95%CI:2.383-4.155）and referral（OR=3.702,95%CI:2.827-4.913）.Patients with newly treated tuberculosis（OR=1.171,95%CI:1.029-1.331）had a higher rate of delay in treatment;Patients with positive etiological tests（OR=2.538,95%CI:2.394-2.691）and no etiological tests（OR=2.199,95%CI:1.854-2.614）had a higher rate of delay in seeing a doctor.4.Investigation results of a tuberculosis cluster epidemic in a school in Panyu DistrictThis is mainly due to the delay in the treatment of the first cases and the cluster epidemic caused by the transmission of tuberculosis among students.The school has the problems of insufficient prevention and control of tuberculosis,insufficient early detection and implementation,insufficient allocation of school doctors,insufficient ventilation and lighting in classrooms and dormitories.According to a survey of 2,693students in the middle school,54.7%were worried that tuberculosis would affect their studies,17.3%thought that if they were diagnosed with tuberculosis,they would be discriminated against and isolated by the people around them,and 5.6%thought that they should keep the secret of tuberculosis.Conclusion1.The overall incidence of tuberculosis in Panyu District of Guangzhou was at a low level and showed a decreasing trend from 2005 to 2020,but the incidence of tuberculosis in middle-aged and elderly population≥45 years old showed an increasing trend in recent years,and the proportion of cases among students in the total population showed an increasing trend.The incidence of tuberculosis is high from April to September,so it is necessary to strengthen tuberculosis prevention and control work in Shatou Street,Shiqi Town,Dashi Street and Shiqiao Street.2.The prediction accuracy of SARIMA-SVM combined model for tuberculosis is higher than that of single SARIMA model,and it can be used to predict the incidence of tuberculosis;It is predicted that the prevalence of tuberculosis in Panyu District is decreasing.3.From 2005 to 2020,the delay rate of tuberculosis patients in Panyu District of Guangzhou was higher than the national level,and the overall trend was on the rise.It is important to pay attention to the population of women,≥30 years old,who are engaged in agriculture,forestry,animal husbandry,fishery and water conservancy,and operators of production and transportation equipment,so as to enhance their vigilance against tuberculosis.4.The main reason for the tuberculosis cluster outbreak in a school in Panyu District was the delay in seeing the first case,which led to the transmission among students.The key to prevent the outbreak of the tuberculosis is to strengthen early detection in schools,implement relevant systems such as morning and afternoon inspection,enhance students’awareness of early report and eliminate concealment.