| Objective:To explore the spatio-temporal distribution of incidence of human brucellosis,patient management from 2016 to 2020 and the status quo of health resources allocation in Xilingol League.And to explore the relationship between the incidence of human brucellosis,patient management and allocation of health resources in Xilingol League in 2020.This study was undertaken to provide references for improving prevention and control strategies of brucellosis and optimizing the health resources allocation.Methods:Based on geographic information system technology（GIS）,the banner or county（district）was defined as the basic unit in this study.Indicators such as incidence,the file created rate,treatment rate,follow-up rate,standardized treatment rate,cure rate and chronicity rate were used to conduct a comprehensive analysis of the brucellosis and patient management from 2016 to 2020.Then the spatial autocorrelation analysis and spatio-temporal scanning were performed to explore the spatio-temporal distribution of them.What’s more,Gini index（Gini）,health resource density index（HRDI）,nuclear density analysis,and buffer zone analysis were used to evaluate the status quo of the of health resources allocation in Xilingol League.And overlay analysis was used to explore the match situation between health institutions and the incidence of brucellosis,patient management level.Finally,the Geographically Weighted Regression model was established to explore the the relationship between the incidence of human brucellosis,patient management and allocation of health resources in 2020.Results:（1）From 2016 to 2020,the incidence of brucellosis ranged from58.08/100,000 to 96.68/100,000 in Xilingol League,which was generally showed an upward trend(Ptrend<0.001).According to the results of spatial autocorrelation analysis,positive spatial correlations were observed in the distribution of the incidence of human brucellosis in 2016 and 2017（Moran’s I=0.1946,P=0.047;Moran’s I=0.2446,P=0.040）.The“low-high”clustering areas of the incidence of human brucellosis were mainly distributed in the southern of Xilingol League.Spatio-temporal scan analysis demonstrated that first-level spatio-temporal clustering areas of high-incidence of human brucellosis were included Sunite Right Banner,Xianghuang Banner,Zhengxiangbai Banner,Taipusi Banner,and Zhenglan Banner in west and south of Xilingol League in 2019 and 2020（RR=1.96,P<0.001）.（2）From 2016 to 2020,the average file created rate of brucellosis patients was97.61%in Xilingol League,which was lower in the west and south areas than that in the east and north areas.The file created rate was lowest in Erenhot City（75.00%）in2016 and in Taipusi Banner（64.76%）in 2017.After 2018,the file created rate of patients were increased significantly in each banner,county（district）,reached 100.00%.According to the results of spatial autocorrelation analysis,the“low-high”clustering areas of the files created rate were mainly distributed in above-mentioned areas.From 2016 to 2020,the treatment rate of brucellosis patients ranged from 89.15%to 96.71%,showed a downward trend(Ptrend=0.035).The treatment rate of patients in Taipusi Banner and Xilinhot fluctuated greatly during the five years,showed a downward-upward-downward trend.The average treatment rate of Taipusi Banner was76.13%,which was the lowest in the league,followed by Xilinhot（87.03%）.Local spatial autocorrelation analysis showed that,the“low-high”clustering areas of treatment rate included Sunite Right Banner and Xilinhot City in 2020（P<0.001）.The follow-up rate in the west and south of Xilingol League were lower.The follow-up rate of Taipusi Banner dropped quickly to 64.76%in 2017 and dropped again to 95.24%in 2020.In 2020,the“low-high”clustering area of follow-up rate was Taipusi Banner（P<0.001）.The standardized treatment rate of brucellosis patients in the west and south were higher than that in the east and north areas.Positive spatial correlations were observed in the distribution of standardized treatment rates of patients in 2016 and 2017,（Moran’s I=0.3218,P=0.039;Moran’s I=0.4669,P=0.009）.In 2020,the“low-high”clustering areas of standardized treatment rate included Sunite Right Banner and Xilinhot City（P<0.001）.From 2016 to 2020,the cure rate of brucellosis patients was ranged from 85.15%to 90.45%in Xilingol League,showed an upward trend（Ptrend=0.010）.The cure rate was lower in the west and south areas than that in the east and north areas.The cure rate in Zhenglan Banner showed a downward trend,decreased from 96.83%in 2016 to85.21%in 2020(Ptrend=0.003).The cure rate of patients fluctuated greatly with time in other areas.Among them,the cure rate of patients in East Ujimqin Banner and Taipusi Banner showed downward-upward-downward trend,which were 91.45%and 87.86%respectively in 2020.The cure rate in Xilinhot City less changed from 2016 to 2020and were lower in the whole league.Among them,the cure rate was the highest at 89.33%in 2018.In 2020,the“high-low”clustering area of cure rate was Duolun County（P<0.05）.From 2016 to 2020,the chronicity rate of patients ranged from 8.81%to 14.85%,showed a downward trend（Ptrend=0.001）,the chronicity rate was higher in the west and south areas than that in the east and north areas.The chronicity rate in Xilinhot City showed a downward-upward trend,which was 13.75%in 2020.Local spatial autocorrelation analysis also showed that in 2020,the“high-low”clustering area of chronicity rate was Xilinhot City（P<0.001）.Spatio-temporal scan analysis also showed that the first-level higher chronicity rate clustering areas included Xilinhot City in 2016（RR=2.15,P<0.001）.（3）To analyze the status quo of health resources allocation in Xilingol League in2020.Compared with 2019,the number of health service institutions increased by1.04%,the number of health technicians decreased by 1.97%,the number of beds decreased by 3.92%in Xilingol League in 2020.The highest HRDI of health institutions was 0.30 in Taipusi Banner,and the highest HRDI of health technicians and beds was 1.73 and 1.14,respectively in Xilinhot City.The Gini coefficients of health institutions,health technicians,and beds allocated according to the population were 0.02,0.07,and 0.14,all of which were less than 0.20,indicating higher equity.The Gini coefficients of health institutions,health technicians,and beds allocated according to geographical distribution were 0.33,0.36,and 0.43,respectively.The allocation of the number of health institutions and health technicians were at a relatively reasonable level,and the allocation of the number of beds was in an unequal state with a large gap.（4）Overlay analysis showed that,in the southern region,the incidence of hunman brucellosis in Zhengxiangbai Banner was high,and the number of health institutions was dense;the treatment rate and follow-up rate of patients in Taipusi Banner were relatively lower in the whole league,the chronicity rate was higher,and the distribution of health institutions was denser.The distribution of health institutions in Xilinhot was relatively sparse,and the treatment rate,standardized treatment rate,and cure rate of patients were relatively lower,and the chronicity rate was relatively higher.The GWR analysis showed that the number of health institutions was positively correlated with the incidence of human brucellosis（regression coefficient:1.341600～1.344300,P<0.001）and chronicity rate（regression coefficient:0.085148～0.085340,P=0.021）,which was negatively correlated with the treatment rate（regression coefficient:-0.019610～-0.019588,P=0.040）,follow-up rate（regression coefficient:-0.0022741～-0.022655,P=0.028）,and the cure rate（regression coefficient:-0.009622～-0.009522,P=0.031）.The number of health technicians was negatively correlated with treatment rate（regression coefficient:-0.002605～-0.002603,P=0.009）,chronicity rate（regression coefficient:-0.001711～-0.001701,P=0.045）,which was positively correlated with follow-up rate（regression coefficient:0.001541～0.001545,P=0.023）,cure rate（regression coefficient:0.002523～0.002528,P=0.047）.Conclusion:（1）From 2016 to 2020,the incidence of human brucellosis in Xilingol League showed an upward trend,and there were spatial clustering areas,and the high incidence clustering areas were mainly concentrated in the south and west of in Xilingol League.（2）Based on GIS analysis,the spatio-temporal distribution patterns of brucellosis patients management were visually displayed in Xilingol League;the management effect in the west and south areas were relatively poor,showed the coexistence of lower files created rate,and follow-up rate,higher treatment rate and standard treatment rate,lower cure rate and higher chronic rate.（3）The spatial distribution of health resources allocation was uneven in Xilingol League.The equity of health resources allocation of population distribution was better than that of geographical distribution.The equity of health material resource allocation was better than that of health human resource.（4）The areas where the incidence of brucellosis,the management of patients and the spatial distribution of health resources were mainly concentrated in the part of west and south areas of Xilingol League,where health institutions were relatively dense and health resources were relatively abundant,but the incidence of human brucellosis was higher,and the level of patient management was lower.（5）The number of health institutions was positively correlated with the incidence of human brucellosis and the chronicity rate of patients,which was negatively correlated with the treatment rate,follow-up rate and cure rate of patients.The number of health technicians was negatively correlated to the treatment rate and chronicity rate of patients,which was positively correlated with the follow-up rate and the cure rate of patients. |
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