| BackgroundWith the social economic level advancing,the life expectancy of Chinese has been constantly increasing.In 1999,China officially entered an aging society.Due to multiple reasons such as immune aging and malnutrition,the elderly are facing the double threats of chronic diseases and infectious diseases,and the infectious diseases in the elderly tend to be more serious and more difficult to treat.At present,studies on diseases of the elderly mainly focuses on chronic diseases and their influencing factors.Due to data accessibility,studies on infectious diseases are limited to notifiable infectious diseases.However,non-notifiable infectious diseases also have high incidence and disease burden in the elderly population,such as pneumonia or herpes zoster,which are less understood.Shandong Multi-Center Healthcare Big Data Platform(SMCHBDP),which integrates multi-source data,provides us a new opportunity to explore the spectrum and influencing factors of infectious diseases among the elderly.ObjectivesThis study aims to describe the spectrum of infectious diseases among the elderly in Shandong Province,analyze the epidemiological characteristics of infectious diseases,determine the main infectious diseases endangering the health of the elderly and the high-risk groups and regions of various diseases.We also aim to explore the influencing factors of infectious diseases,and to provide scientific evidence for rational allocation of health resources and promotion of the health among the elderly population.MethodsWe extracted case information of all elderly aged over 60 years registered on SMCHBDP from 1 January 2013 to 30 June 2017.The spectrum and epidemiological characteristics of infectious diseases among the elderly were analyzed,and logarithmic linear regression was conducted to calculate the annual percentage change of infectious diseases.The effect of demographic factors on the incidence density of infectious diseases was analyzed through the Poisson regression analysis.In addition,the ecological research was carried out at the population level,and a multi-level model was adopted to further explore the association between the major infectious diseases in this group,i.e.respiratory infectious diseases,and ecological influencing factors.Finally,a cohort study of diabetes mellitus was conducted and Cox proportional hazards regression model was adopted to explore the effect of diabetes mellitus on the risk of various infectious diseases.Results1.Spectrum and epidemiological characteristics of infectious diseases(1)Temporal distribution:From 1 January 2013 to 30 June 2017,there were 550432 elderly persons included in this study,and a total of 27595 cases of infectious diseases were reported,covering 102 infectious diseases in 5 disease categories.The incidence density of respiratory and mucocutaneous infectious diseases showed an increasing trend,with annual percent change(APC)of 17.45%(P=0.03)and 20.44%(P=0.02),respectively.Gastrointestinal,vector-borne,and blood-and sex-transmitted infectious diseases were relatively stable.Furthermore,influenza had the highest level in the elderly,followed by herpes zoster.Pneumonia has been the third most prevalent disease in the elderly since 2014.Additionally,the incidence density of herpes zoster and pneumonia showed an increasing trend,with APC of 28.16%(P=0.008)and 81.55%(P=0.005),respectively.(2)Spatial distribution:The main types of infectious diseases among the elderly in each city of Shandong Province were respiratory and mucocutaneous infectious diseases.The leading disease was different among the elderly in different cities.The annual incidence of various diseases in Jiaodong Peninsula area remained at a high level in the whole province.From 2013 to 2014,the incidence density of all categories of infectious diseases in rural areas was generally low,but increased rapidly from 2015 to 2017.The incidence density of respiratory,gastrointestinal,and vector-borne diseases in rural areas gradually surpassed that in urban areas.The incidence of blood and sex-transmitted diseases and mucocutaneous diseases increased significantly in rural areas,but the incidence density did not exceed that in urban areas.(3)Population distribution:The risk of various infectious diseases in elderly male was higher than that in female,and the effect of old age on respiratory diseases was particularly significant.After adjusting the age and urban-rural distribution,the risk of respiratory infectious diseases in males was about three times than that of females(IRRa=2.94,95%CI:2.89,3.00).In addition,the risk of respiratory disease was nearly 10 times higher for those aged 85-89 than those aged 60-64(IRRa=9.85,95%CI:9.39,10.33).2.Ecological study on influencing factors of respiratory infectious diseasesThe incidence density of respiratory infectious diseases in the elderly increased with population density(β=0.21,P=0.07),per capita GDP(β=0.42,P<0.001),number of hospital beds(β=0.43,P<0.001),and decreased with emissions of industrial nitrogen oxides(β=-0.25,P=0.005).Among them,per capita GDP and number of hospital beds had a greater impact on respiratory infectious diseases in the elderly.3.Cohort study of diabetes mellitus for the incidence of infectious diseasesAmong 550432 elderly persons,there were 67865 cases with diabetes mellitus history,and the approximate prevalence was 12.33%.After adjusting for age,gender and urban-rural distribution,diabetes increased the risk of infectious diseases among the elderly,including influenza(HR=1.74,95%CI:1.64,1.85),herpes zoster(HR=1.69,95%CI:1.56,1.84),and pneumonia(HR=1.74,95%CI:1.53,1.98).Conclusions1.Respiratory and mucocutaneous infectious diseases are the major infectious diseases in the elderly.Influenza,herpes zoster,and pneumonia are the main infectious diseases threatening the health of the elderly.Therefore,taking comprehensive policies and measures is suggested to promote the prevention and control of the major infectious diseases among the elderly.2.The incidence density of all categories of infectious diseases among the elderly in rural areas was increasing during the study period,and the incidence density of respiratory,gastrointestinal,and vector-borne diseases are higher than that in urban areas.This may indicate that the aging problem is more serious in rural areas than in urban areas.Hence,the government and relevant departments should actively promote the medical and health care reform in rural areas,and effectively improve the fairness and accessibility of medical services in rural areas.3.Old age is an independent risk factor affecting the incidence of respiratory infectious diseases in the elderly.The elderly persons over 80 years are at significantly higher risk of developing respiratory infectious diseases.It is suggested to focus on the corresponding highrisk groups for different infectious diseases.4.The number of beds and GDP per capita in local hospitals are positively correlated with the incidence density of infectious diseases among the elderly.The improvement of social economy and medical conditions may affect people’s medical behaviors.5.The elderly with diabetes mellitus have a higher risk of developing infectious diseases than those without diabetes mellitus.It is suggested that relevant medical institutions at all levels should strengthen the screening and monitor of infectious diseases in patients with diabetes mellitus,reduce the probability of subsequent infection caused by diabetes mellitus,and improve their health and quality of life. |
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