Analysis on the epidemiological characteristics and disease burden of Japanese encephalitis in Gansu Province
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摘要:
目的 探讨甘肃省2017-2018年流行性乙型脑炎(简称乙脑)的流行病学特征和疾病负担。 方法 利用甘肃省2017年1月1日-2018年12月31日乙脑病例数据和随访数据，计算乙脑的发病率、死亡率、病死率以及潜在减寿年数，比较不同分组的乙脑病例病情转归情况，采用二项Logistic回归分析模型分析甘肃省乙脑患者病情转归的主要影响因素。 结果 乙脑发病率、死亡率以及病死率随着年龄增长而增加。不同年龄(H=61.797, P＜0.001)、不同临床分型(H=53.953, P＜0.001)、有无意识障碍(H=64.367, P＜0.001)以及有无脑膜刺激征(H=5.251, P=0.022)的乙脑病例病情转归比较均有统计学差异。二项Logistic逐步回归分析模型结果显示，年龄(OR=3.217, P＜0.001)、临床分型(OR=1.621, P＜0.001)及有无意识障碍(OR=1.969, P=0.002)对甘肃省乙脑病例病情转归的影响均有统计学意义。甘肃省2017年和2018年乙脑病例的潜在寿命损失分别为945.84人年和1 056.92人年，0~ < 15岁损失最小，女性损失高于男性。 结论 成人乙脑发病率、死亡率及病死率均高于儿童，乙脑造成的潜在寿命损失也主要以成人为主，影响乙脑病例转归的主要因素为年龄、临床分型以及有无意识障碍。 Abstract:Objective To explore the epidemiological characteristics and disease burden of Japanese encephalitis (JE) in Gansu Province from 2017 to 2018. Methods We calculated the JE morbidity, mortality, case fatality rate, and potential years of life loss by using JE case data and its follow-up data from 1 January 2017 to 31 December 2018. We compared the disease outcome of JE cases in different groups and performed binomial logistic regression analysis to explore the main influencing factors of the prognosis of JE patients in Gansu Province. Results The incidence, mortality and mortality of JE increased significantly with age. There were statistically significant differences in the outcome of JE cases with different ages (H=61.797, P < 0.001), different clinical types (H=53.953, P < 0.001), with or without conscious disturbance (H=64.367, P < 0.001), and with or without meningeal irritation (H=5.251, P=0.022). Binomial logistic stepwise regression results showed that age (OR=3.217, P < 0.001), clinical classification (OR=1.621, P < 0.001), and consciousness disorder (OR=1.969, P=0.002) had statistical significance in the outcome of JE cases in Gansu Province. In 2017 and 2018, the potential life loss of JE cases in Gansu Province was 945.84 person-years and 1 056.92 person-years, respectively. The loss of children was the smallest, and the loss of women was higher than that of men. Conclusion Compared with children, the morbidity, mortality, and fatality rate of adults JE are higher, and the potential life loss caused by JE is mainly in adults. The main factors affecting the outcome of JE cases are age, clinical classification and consciousness disorders. -
Key words:
- Japanese encephalitis /
- Epidemiological burden /
- Disease outcome /
- Influencing factors
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表 1 甘肃省2017年乙脑发病率、死亡率及病死率
Table 1. Incidence, mortality and mortality rate of JE in Gansu Province in 2017
年龄(岁) N(万人) 发病 死亡 病死率(%) n(例) 率(/10万) n(例) 率(/10万) 0~ < 15 456.82 17 0.372 1 1 0.021 9 5.88 15~ < 65 1 882.33 268 1.423 8 34 0.180 6 12.69 ≥65 278.69 77 2.762 9 30 1.076 5 38.96 合计 2 617.83 362 1.382 8 65 0.248 3 17.96 γ值 0.462 0.761 0.621 P值 ＜0.001 ＜0.001 ＜0.001 
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表 2 甘肃省2018年乙脑发病率、死亡率及病死率
Table 2. Incidence, mortality and mortality rate of JE in Gansu Province in 2018
年龄(岁) N(万人) 发病 死亡 病死率(%) n(例) 率(/10万) n(例) 率(/10万) 0~ < 15 459.86 18 0.391 4 0 0.000 0 0.00 15~ < 65 1 879.79 321 1.707 6 47 0.250 0 14.64 ≥65 291.84 165 5.653 8 61 2.090 2 36.97 合计 2 631.49 504 1.915 3 108 0.410 4 21.43 γ值 0.602 0.846 0.585 P值 ＜0.001 ＜0.001 ＜0.001
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表 3 不同分组的乙脑病例病情转归比较[n (%)]
Table 3. Comparison of the outcome of JE cases in different groups [n (%)]
分组 赋值 病情转归 H值 P值 痊愈 好转 有后遗症 死亡 年龄(岁) 61.797 ＜0.001 0~ < 15 1 20(76.92) 5(19.23) 0(0.00) 1(3.85) 15~ < 65 2 270(52.33) 100(19.38) 65(12.60) 81(15.70) ≥65 3 68(30.91) 32(14.55) 29(13.18) 91(41.36) 性别 0.624 0.430 男 1 169(46.17) 59(16.12) 52(14.21) 86(23.50) 女 2 189(47.73) 78(19.70) 42(10.61) 87(21.97) 临床分型 53.953 ＜0.001 轻型 1 79(61.72) 25(19.53) 14(10.94) 10(7.81) 中型 2 138(53.28) 40(15.44) 34(13.13) 47(18.15) 重型 3 80(34.33) 43(18.45) 25(10.73) 85(36.48) 极重型 4 3(14.29) 6(28.57) 0(0.00) 12(57.14) 起病急 0.711 0.399 有 1 316(46.06) 125(18.22) 85(12.39) 160(23.32) 无 0 35(50.72) 12(17.39) 9(13.04) 13(18.84) 意识障碍 64.367 ＜0.001 有 1 174(36.94) 87(18.47) 63(13.38) 147(31.21) 无 0 179(63.03) 50(17.61) 31(10.92) 24(8.45) 脑膜刺激征 5.251 0.022 有 1 158(42.47) 77(20.70) 40(10.75) 97(26.08) 无 0 192(51.75) 55(14.82) 49(13.21) 75(20.22)
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表 4 二项分类Logistic逐步回归分析模型分析结果
Table 4. Binomial logistic stepwise regression analysis results
模型 β值 sb Wald χ2值 OR值 P值 年龄 1.169 0.180 41.958 3.217 ＜0.001 临床分型 0.483 0.131 13.676 1.621 ＜0.001 有意识障碍 0.678 0.224 9.146 1.969 0.002 常数 -4.872 0.525 85.981 0.008 ＜0.001 注：P＜0.05纳入变量，P＞0.1剔除变量。
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表 5 甘肃省2017-2018年乙脑年龄别、性别PYLLs
Table 5. PYLLs by age and gender of JE in Gansu Province, 2017-2018
年龄(岁) 2017年 2018年 男 女 合计 男 女 合计 0~ < 15 0.00 66.56 66.56 0.00 0.00 0.00 15~ < 30 48.10 257.0 305.90 96.20 51.56 147.76 30~ < 45 66.20 73.12 139.32 132.40 109.68 242.08 45~ < 60 162.90 129.36 292.26 181.00 215.60 396.60 60~ < 75 43.40 98.40 141.80 86.80 183.68 270.48 ≥75 0.00 0.00 0.00 0.00 0.00 0.00 合计 320.60 625.24 945.84 496.40 560.52 1 056.92
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