Study on influencing factors of spatial and temporal distribution difference of tuberculosis in Ningxia from 2004-2019
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摘要:
目的 探讨宁夏回族自治区(简称宁夏)肺结核时空分布差异的可能影响因素，可为深入认识肺结核的传播机制提供参考依据。 方法 根据宁夏2004―2019年肺结核标准化发病比(standardized morbidity ratio, SMR)数据，运用空间杜宾模型(spatial Dubin model，SDM)分析宁夏肺结核发病时空分布差异的可能影响因素。 结果 SDM显示日照时数(β=0.000 336 4，P=0.021)、卫生机构数(β=0.003 058 8，P < 0.001)和人均国内生产总值(gross domestic product, GDP)(δ=0.000 013 3，P < 0.001)与宁夏肺结核SMR呈正相关，而降水量(δ=-0.000 919 9，P=0.028)和卫生机构人员数(β=-0.000 109 2，P=0.005；δ=-0.000 148 0，P=0.034)与宁夏肺结核SMR呈负相关。日照时数、卫生机构数和卫生机构人员数表现为直接效应，降水量、人均GDP和卫生机构人员数表现为间接效应，其中人均GDP具有正向的空间溢出效应，而降水量和卫生机构人员数具有负向的空间溢出效应。 结论 宁夏肺结核发病的空间聚集性可能与经济发展水平(人口流动性)、干旱日照长的气候环境和医疗卫生资源配置等因素有关，建议相关部门调整相应的政策以提升宁夏不同县(区)间的肺结核防制能力。 Abstract:Objective The purpose of this study was to explore the potential influencing factors of the Spatio-temporal distribution difference of tuberculosis in Ningxia Hui Autonomous Region (referred to as "Ningxia"), which may provide a reference for an in-depth understanding of the transmission mechanism of tuberculosis. Methods Based on the standardized morbidity ratio (SMR) data of tuberculosis in Ningxia from 2004 to 2019, the spatial Dubin model (SDM) was established to analyze the potential influencing factors of the Spatio-temporal distribution difference of tuberculosis in Ningxia. Results The SDM showed that the sunshine hours (β=0.000 336 4, P=0.021), the number of health institutions (β=0.003 058 8, P < 0.001) and per capita gross domestic product (GDP) (δ=0.000 013 3, P < 0.001) were positively correlated with SMR, while precipitation (δ= -0.000 919 9, P=0.028) and the number of health institution personnel (β= -0.000 109 2, P=0.005; δ= -0.000 148 0, P=0.034) were negatively correlated with SMR. The sunshine hours, the number of health institutions and the number of health institution personnel showed the direct effects. Precipitation, the per capita GDP and the number of health institution personnel dispalyed the indirect effects, where per capita GDP had a positive spatial spillover effect, and precipitation and the number of health institution personnel has a negative spatial spillover effect. Conclusions The study shows that the Spatio-temporal cluster of tuberculosis in Ningxia may be related to the economic development level (population mobility), the climate environment with drought and long sunshine, and the allocation of medical and health resources. Thus, it is suggested that relevant departments adjusted the corresponding policies to improve the tuberculosis prevention and control ability among different counties (districts) in Ningxia. -
Key words:
- Tuberculosis /
- Standardized morbidity ratio /
- Influencing factors /
- Spatial Dubin model
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表 1 变量信息列表
Table 1. List of variable information
变量名称 具体指标 气象因素 日最高气温 日最低气温 日平均气温 最大风速 平均风速 降水量 日照时数 社会经济因素 人均国内生产总值(gross domestic product, GDP) 医疗卫生因素 卫生机构数 卫生机构人员数 卫生机构床位数 
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表 2 LM检验
Table 2. LM test
检验 统计值 P值 SEM 莫兰指数 4.197 ＜0.001 LM 14.481 ＜0.001 稳健性LM 2.411 0.120 SLM LM 12.128 ＜0.001 稳健性LM 0.058 0.809
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表 3 稳健性分析
Table 3. Robust analysis
类型 LR检验 Wald检验 比较SDM与SLM χ2值 32.19 54.64 P值 < 0.001 < 0.001 比较SDM与SEM χ2值 32.11 51.70 P值 < 0.001 < 0.001
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表 4 不同气温与风速组合的模型比较
Table 4. Model comparison of different air temperature and wind speed combinations
气温 风速 R2值 对数似然函数值 平均 平均 0.000 1 -24.831 4 最高 平均 0.000 5 -24.730 5 最低 平均 0.003 2 -24.805 2 平均 最高 0.005 5 -24.737 7 最高 最高 0.003 3 -24.729 6 最低 最高 0.006 2 -24.564 2
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表 5 最优效应选择的检验分析
Table 5. Test analysis of optimal effect selection
类型 χ2值 P值 Hausman检验 305.84 < 0.001 比较个体固定效应与双向固定效应 22.79 0.012 比较时间固定效应与双向固定效应 150.13 < 0.001
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表 6 空间杜宾模型结果
Table 6. Results of spatial Durbin model
TB_SMR 系数 sx值 Z值 P值 (95% CI)值 Main 日照时数 0.000 336 4 < 0.001 2.300 0.021 0.000~0.001 卫生机构数 0.003 058 8 0.001 6.020 < 0.001 0.002~0.004 卫生机构人员数 -0.000 109 2 < 0.001 -2.810 0.005 -0.000~-0.000 Wx 降水量 -0.000 919 9 < 0.001 -2.200 0.028 -0.002~-0.000 人均GDP 0.000 013 3 < 0.001 4.250 < 0.001 0.000~0.000 卫生机构人员数 -0.000 148 0 < 0.001 -2.120 0.034 -0.000~-0.000 Spatial rho -0.103 115 9 0.072 -1.440 0.151 -0.244~0.038 Variance sigma2_e 0.067 133 1 0.005 13.250 < 0.001 0.057~0.077
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表 7 各影响因素对宁夏肺结核SMR的效应分解情况
Table 7. Effect decomposition of the influencing factors on SMR of tuberculosis in Ningxia
变量 直接效应 间接效应 总效应 降水量 0.002 053 000(0.510) -0.000 870 500(0.029) -0.000 665 200(0.018) 日照时数 0.000 351 900(0.012) -0.000 123 900(0.594) 0.000 228 000(0.365) 人均GDP -0.000 000 394(0.787) 0.000 012 500(< 0.001) 0.000 012 100(< 0.001) 卫生机构数 0.003 073 400(< 0.001) 0.000 993 600(0.250) 0.004 067 100(< 0.001) 卫生机构人员数 -0.000 106 900(0.008) -0.000 131 600(0.045) -0.000 238 500(< 0.001) 注：括号内为P值。
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