The epidemic trend and spatial distribution of newly reported HIV/AIDS cases in Liuzhou City from 2005 to 2023
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摘要:
目的 分析广西壮族自治区柳州市2005―2023年新报告人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染者和艾滋病(acquired immunodeficiency syndrome, AIDS)患者(简称HIV/AIDS)的时空分布特征和变化趋势，为柳州市艾滋病防治工作提供参考。 方法 基于2005―2023年柳州市新报告HIV/AIDS病例数，采用Joinpoint回归模型进行时间趋势分析，使用全局和局部空间自相关分析探索柳州市AIDS疫情空间聚集性，采用SaTScan软件进行时空扫描分析，并利用ArcGIS 10.8软件实现结果可视化，以年度变化百分比(annual percent change, APC)和转折点将2005―2023年划分为不同的研究阶段进行处理。 结果 Joinpoint回归模型分析结果显示，2005―2011年柳州市HIV/AIDS病例新发现率呈单调上升趋势(APC=10.17%, P=0.026)，2020―2023年呈单调下降趋势(APC=-8.51%, P=0.027)。2005―2023年柳州市≥55岁人群感染者占比从49.70%增至63.92%，异性性传播占比从66.27%增至87.27%。全局空间自相关表明，病例分布存在显著全局空间正相关，全局莫兰指数范围为0.212~0.398(均P＜0.001)。局部空间自相关表明，2005―2011年“高-高”聚集区和热点区域集中在柳州市东部中渡镇、鹿寨镇等乡镇，2021―2023年转移至成团镇、百朋镇等西部乡镇。时空扫描识别出5个显著性时空聚集区，在时间和空间上均具有一定的聚集性(均P＜0.05)。 结论 2005―2023年柳州市HIV/AIDS疫情呈现“由东部向中西部迁移”的时空动态特征，老年人群和异性性传播为防控重心，建议针对重点区域加强监测，并结合人口学特征制定干预策略。 Abstract:Objective This study aimed to analyze the spatiotemporal distribution characteristics and changing trends of newly reported human immunodeficiency virus (HIV) - infected individuals and acquired immunodeficiency syndrome (AIDS) patients (simply called HIV/AIDS) in Liuzhou City, Guangxi Zhuang Autonomous Region from 2005 to 2023, so as to provide references for the AIDS prevention and control work in Liuzhou. Methods Based on the number of newly reported HIV/AIDS cases in Liuzhou from 2005 to 2023, the Joinpoint regression model was used to analyze the temporal trend, the global and local spatial autocorrelation analysis was used to explore the spatial aggregation of HIV/AIDS epidemic in Liuzhou, and the SaTScan software was used for spatial and temporal scanning analysis, and ArcGIS 10.8 software was used to visualize the results, divide the period from 2005 to 2023 into different research stages based on annual percentage change (APC) and turning points for processing. Results Joinpoint regression analysis showed that the new detection rate of HIV/AIDS in Liuzhou presented a monotonically increasing trend from 2005 to 2011 (APC=10.17%, P=0.026) and a monotonically decreasing trend from 2020 to 2023 (APC=-8.51%, P=0.027). During the study period, the proportion of infected persons aged 55 and above increased from 49.7% to 63.92%, and the proportion of heterosexual transmission rose from 66.27% to 87.27%. Global spatial autocorrelation analysis indicated that there was a significant positive global spatial correlation in the distribution of cases, with the global Moran's I ranging from 0.212 to 0.379 (all P < 0.001). Local spatial autocorrelation analysis revealed that from 2005 to 2011 the high-high clusters and hotspots were concentrated in towns such as Zhongdu Town and Luzhai Town in eastern Liuzhou from 2021 to 2023 they shifted to western towns such as Chengtuan Town and Baipeng Town. Spatiotemporal scanning identified 5 significant clusters, which showed certain aggregation in both time and space (all P < 0.05). Conclusions The HIV/AIDS epidemic in Liuzhou City shows the spatiotemporal dynamic characteristic of "migration from the eastern region to the central and western regions". The elderly population and heterosexual transmission are the key focuses of prevention and control. It is suggested to strengthen surveillance in key areas and formulate intervention strategies in combination with demographic characteristics. -
图 1 2005―2023柳州市新报告HIV/AIDS病例新发现率趋势分析
HIV：人类免疫缺陷病毒；AIDS：艾滋病；APC：年度变化百分比; 红色散点代表不同年份对应的新发现率；曲线为经Joinpoint回归对红色散点进行拟合的结果；曲线不同颜色分段提示存在Joinpoint变化点；a: P＜0.05。
Figure 1. Trend analysis on the new detection rate of newly reported HIV/AIDS cases in Liuzhou from 2005 to 2023
HIV: human immunodeficiency virus; AIDS: acquired immunodeficiency syndrome; APC: annual percent change; The red scatter points represent the new detection rates corresponding to different years; The curve is the fitting result of the red scatter points using Joinpoint regression; Different color segments on the curve indicate the presence of Joinpoint change points; a: P < 0.05.
图 2 2005―2023年柳州市各乡镇(街道)新报告HIV/AIDS分阶段空间分布情况
HIV：人类免疫缺陷病毒；AIDS：艾滋病。
Figure 2. Spatial distribution of new reported HIV/AIDS by stages in each township street of Liuzhou City from 2005 to 2023
HIV: human immunodeficiency virus; AIDS: acquired immunodeficiency syndrome.
图 3 2005―2023年柳州市各乡镇(街道)新报告HIV/AIDS分阶段LISA情况
HIV：人类免疫缺陷病毒；AIDS：艾滋病; LISA: 局部空间自相关。
Figure 3. Staged LISA results of newly reported HIV/AIDS by stages in township streets of Liuzhou City from 2005 to 2023
HIV: human immunodeficiency virus; AIDS: acquired immunodeficiency syndrome; LISA: local indicators of spatial association.
图 4 2005―2023年柳州市各乡镇街道新报告HIV/AIDS分阶段热点分析
HIV：人类免疫缺陷病毒；AIDS：艾滋病。
Figure 4. Hotspot analysis of new reported HIV/AIDS cases by stages in township streets of Liuzhou City from 2005 to 2023
HIV: human immunodeficiency virus; AIDS: acquired immunodeficiency syndrome.
图 5 2005―2023年柳州市各乡镇街道新报告HIV/AIDS病例时空扫描聚集分析结果
HIV：人类免疫缺陷病毒；AIDS：艾滋病。
Figure 5. Spatio-temporal scan clustering analysis results of newly reported HIV/AIDS cases in each township street of Liuzhou City from 2005 to 2023
HIV: human immunodeficiency virus; AIDS: acquired immunodeficiency syndrome.
表 1 2005―2023年柳州市新报告HIV/AIDS基本情况
Table 1. Basic situation of newly reported HIV/AIDS in Liuzhou from 2005 to 2023
变量Variable 合计
Total2005―2011年year① 2012―2017年year① 2018―2020年year① 2021―2023年year① χ2值
valueP值
value性别Gender 30.289② ＜0.001 男Male 15 939 6 157(68.30) 5 457(71.80) 2 346(71.70) 1 979(69.20) 女Female 6 808 2 861(31.70) 2 139(28.20) 927(28.30) 881(30.80) 年龄/岁Age/years 32.342③ ＜0.001 ＜25 225 97(1.08) 42(0.55) 33(1.02) 53(1.85) 25~＜35 684 50(0.55) 284(3.74) 186(5.68) 164(5.73) 35~＜45 3 150 1 377(15.27) 1 160(15.27) 332(10.14) 281(9.83) 45~＜55 5 643 3 012(33.40) 1 548(20.38) 549(16.77) 534(18.67) ≥55 13 045 4 482(49.70) 4 562(60.06) 2 173(66.39) 1 828(63.92) 民族Nationality 48.357② ＜0.001 汉族Han nationality 11 912 4 923(54.60) 4 058(53.40) 1 589(48.50) 1 342(46.90) 壮族Zhuang nationality 8 677 3 159(35.00) 2 982(39.30) 1 355(41.40) 1 181(41.30) 其他Others 2 158 936(10.40) 556(7.30) 329(10.10) 337(11.80) 文化程度Degree of education 11.988③ ＜0.001 小学及以下Elementary school and below 10 746 4 061(45.03) 3 460(45.55) 1 729(52.83) 1 496(52.31) 初中Junior high school 8 871 3 835(42.53) 3 080(40.55) 1 054(32.20) 902(31.54) 高中及以上High school and above 3 130 1 122(12.44) 1 056(13.90) 490(14.97) 462(16.15) 职业Occupation 214.017② ＜0.001 农民Farmer 12 616 4 380(48.57) 4 514(59.43) 2 074(63.36) 1 648(57.62) 待业或无业Unemployment or unemployment 4 484 1 907(21.15) 1 404(18.48) 554(16.93) 619(21.64) 其他Others 5 647 2 731(30.28) 1 678(22.09) 645(19.71) 593(20.74) 婚姻状况Marital status 132.262② ＜0.001 未婚Unmarried 5 469 2 192(25.65) 1 829(24.11) 752(22.99) 696(24.36) 已婚或同居Married or cohabiting 12 299 5 059(59.20) 4 180(55.09) 1 677(51.27) 1 383(48.41) 分居、离异或丧偶Separation, divorce, or widowhood 4 493 1 295(15.15) 1 578(20.80) 842(25.74) 778(27.23) 感染途径Route of infection 1 454.644② ＜0.001 同性性传播Same-sex transmission 673 56(0.63) 296(3.89) 168(5.12) 153(5.32) 异性性传播Heterosexual transmission 17 568 5 924(66.27) 6 372(83.64) 2 764(84.24) 2 508(87.27) 其他Others 4 471 2 959(33.10) 950(12.47) 349(10.64) 213(7.41) 注：①以例数(占比%)表示；② χ2值；③趋势χ2值。
Note: ① Expressed as examples (proportion/%); ② χ2 value; ③ Trend χ2 values.
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表 2 2005―2023年柳州市各乡镇(街道)新报告HIV/AIDS分阶段全局空间自相关情况
Table 2. Global spatial autocorrelation of newly reported HIV/AIDS in each township street of Liuzhou city from 2005 to 2023
年份Year 莫兰指数
Moran's Iχ2值
valueP值
value2005―2011 0.398 7.675 ＜0.001 2012―2017 0.295 5.411 ＜0.001 2018―2020 0.281 5.125 ＜0.001 2021―2023 0.212 3.933 ＜0.001 注：HIV，人类免疫缺陷病毒；AIDS，艾滋病。
Note: HIV, human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome.
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