云南省滇東北地區(qū)肺結(jié)核時空分布特征及影響因素研究
發(fā)布時間：2018-08-20 14:20
【摘要】：結(jié)核病(tuberculosis,TB)由結(jié)核分枝桿菌導(dǎo)致,通常感染并破壞肺(稱“肺結(jié)核”),是嚴重危害人類健康的呼吸道傳染病。結(jié)核病在全球流行廣泛,我國病人數(shù)全球第三。為有效控制結(jié)核病,中國在2011年出臺了第十二個國家結(jié)核病防治規(guī)劃。五年規(guī)劃的實施,有效降低了中國結(jié)核病負擔。然而,位于云南省滇東北地區(qū)的昭通市結(jié)核病疫情仍然較高,高于同期全省和全國的平均水平。國內(nèi)外研究顯示,結(jié)核病具有時空的異構(gòu)分布,其分布特征與個人行為和社會經(jīng)濟等因素有關(guān)。掌握肺結(jié)核的空間分布特征及風險影響因子等信息對于有效的預(yù)防與控制相關(guān)疫情非常重要。本研究運用時空掃描統(tǒng)計量方法,探討昭通市肺結(jié)核疫情的時空分布特征,找出聚集區(qū)域;應(yīng)用Logistic回歸模型分析影響肺結(jié)核聚集性的生物學因素、個人行為因素、社會經(jīng)濟狀況以及環(huán)境因素等影響因素;最后對個人行為因素中的肺結(jié)核患者就醫(yī)行為進行重點研究,深入探討云南省肺結(jié)核疫情的影響因素,為今后制定結(jié)核病防治策略、改進防治措施、優(yōu)化資源配置等提供科學依據(jù)。主要研究方法和結(jié)果如下:第一部分 云南省滇東北地區(qū)肺結(jié)核病例的時空分布特征研究本研究應(yīng)用時間序列和時空掃描統(tǒng)計量方法探測昭通市2011-2015年間肺結(jié)核病例在鄉(xiāng)鎮(zhèn)水平的時空聚集特征。結(jié)果顯示:昭通市肺結(jié)核呈非隨機分布,具有一定的時空聚集性。時間分布顯示出明顯季節(jié)趨勢,發(fā)病高峰多在冬季,而登記高峰出現(xiàn)在春季,昭通市的總肺結(jié)核登記率共識別出1個最可能的聚集區(qū)和6個次級聚集區(qū),初治登記率有1個最可能的聚集區(qū)和5個次級聚集區(qū),復(fù)治登記率有1個最可能的聚集區(qū)。這三個指標的最可能聚集區(qū)均位于昭通市東南部的鎮(zhèn)雄縣,鎮(zhèn)雄縣人口眾多且社會經(jīng)濟發(fā)展滯后,是肺結(jié)核控制工作應(yīng)該優(yōu)先考慮的地區(qū)。第二部分云南省滇東北地區(qū)肺結(jié)核空間聚集性影響因素研究本研究以2015年10月-2016年2月期間到昭通市所轄11個縣級疾控中心就診的活動性肺結(jié)核患者為研究對象,通過對聚集區(qū)內(nèi)外肺結(jié)核患者的生物學因素、個人行為因素、社會經(jīng)濟狀況、環(huán)境因素等進行Logistic回歸分析探討肺結(jié)核聚集性分布的影響因素,從而為結(jié)核病防控工作提供理論和技術(shù)支持。結(jié)果顯示,與空間聚集區(qū)獨立相關(guān)的因素是患有慢性支氣管炎、居住地在城區(qū)、吸煙、以煤炭為家庭做飯取暖主要燃料,提示昭通市肺結(jié)核的防控措施應(yīng)重點考慮此類人群。第三部分肺結(jié)核患者就醫(yī)行為對肺結(jié)核流行的影響研究本研究對昭通市2015年10月-2016年2月期間登記的肺結(jié)核患者進行結(jié)核病防治知識、就醫(yī)行為以及診療情況問卷調(diào)查。結(jié)果顯示,患者對肺結(jié)核相關(guān)知識的認識不夠全面,調(diào)查對象中只有55.0%知道我國對肺結(jié)核檢查治療實行的政策。與聚集區(qū)外患者相比,聚集區(qū)內(nèi)患者確診延誤時間較長,首診更多的選擇到基層醫(yī)療機構(gòu)就診,初診結(jié)果多為感冒、氣管炎和支氣管炎,從發(fā)病到前往縣級結(jié)防機構(gòu)就診前經(jīng)歷了較多的就診次數(shù),復(fù)治病例和結(jié)核性胸膜炎病例登記比例較高,患者全程督導(dǎo)比例較低,看服藥人員多為家人。聚集區(qū)內(nèi)外患者在就醫(yī)行為上的差異,可能會影響肺結(jié)核在該區(qū)域內(nèi)的發(fā)生發(fā)展。
[Abstract]:Tuberculosis (TB), caused by Mycobacterium tuberculosis, usually infects and destroys the lungs (known as "tuberculosis"), is a respiratory infectious disease that seriously endangers human health. TB is a worldwide epidemic with the third largest number of patients in the world in China. To effectively control TB, China launched the 12th National Tuberculosis Control Plan in 2011. The implementation of the five-year plan has effectively reduced the burden of tuberculosis in China. However, the epidemic situation of tuberculosis in Zhaotong City, northeastern Yunnan Province, is still high, which is higher than the average level of the whole province and the whole country in the same period. Mastering the spatial distribution characteristics and risk factors of pulmonary tuberculosis is very important for effective prevention and control of related epidemics. This study explored the spatial-temporal distribution characteristics of pulmonary tuberculosis epidemic in Zhaotong City by using spatio-temporal scanning statistics, and found out the aggregation areas. Logistic regression model was used to analyze the occurrence of pulmonary tuberculosis aggregation. In the end, the medical behavior of pulmonary tuberculosis patients among individual behavior factors was studied, and the influencing factors of pulmonary tuberculosis epidemic situation in Yunnan Province were discussed in detail, which provided reference for formulating tuberculosis prevention and control strategy, improving prevention and control measures, optimizing resource allocation and so on. The main research methods and results are as follows: The first part is the study on the spatial-temporal distribution of tuberculosis cases in northeastern Yunnan Province. This study used time series and time-space scanning statistics to detect the spatial-temporal aggregation characteristics of tuberculosis cases in Zhaotong from 2011 to 2015. The time distribution shows a clear seasonal trend, the peak of incidence occurs mostly in winter, and the registration peak occurs in spring. The total registration rate of tuberculosis in Zhaotong City identifies one most likely cluster area and six secondary clusters, and the initial treatment registration rate has one most likely cluster area and five secondary clusters. The most likely areas of the three indicators are located in Zhenxiong County in the southeast of Zhaotong City. Zhenxiong County has a large population and lags behind the social and economic development. It is a priority area for tuberculosis control work. Part two: Influencing factors of spatial aggregation of tuberculosis in northeastern Yunnan Province. In this study, 11 active pulmonary tuberculosis patients who visited Zhaotong CDC from October 2015 to February 2016 were selected as the subjects. The aggregation of pulmonary tuberculosis was investigated by logistic regression analysis of the biological factors, personal behavior factors, social and economic conditions, environmental factors and so on. The results showed that the independent factors related to the spatial agglomeration area were chronic bronchitis, living in urban areas, smoking, and using coal as the main fuel for cooking and heating at home, suggesting that the prevention and control measures of tuberculosis in Zhaotong City should focus on such populations. A questionnaire survey was conducted among the registered pulmonary tuberculosis patients in Zhaotong from October 2015 to February 2016. The results showed that the patients'knowledge about tuberculosis was not comprehensive enough, and only one of the respondents was involved in the survey. 55.0% knew the policy of tuberculosis examination and treatment in China.Compared with the patients outside the agglomeration area, the patients in the agglomeration area had a longer time delay in diagnosis and more choice to go to the primary medical institutions for treatment. The number of retreats, the registration rate of tuberculous pleurisy and tuberculous pleurisy were higher, the proportion of patients supervised during the whole course was lower, and the medical staff were mostly family members.
【學位授予單位】：中國疾病預(yù)防控制中心
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R521
本文編號：2193921
[Abstract]:Tuberculosis (TB), caused by Mycobacterium tuberculosis, usually infects and destroys the lungs (known as "tuberculosis"), is a respiratory infectious disease that seriously endangers human health. TB is a worldwide epidemic with the third largest number of patients in the world in China. To effectively control TB, China launched the 12th National Tuberculosis Control Plan in 2011. The implementation of the five-year plan has effectively reduced the burden of tuberculosis in China. However, the epidemic situation of tuberculosis in Zhaotong City, northeastern Yunnan Province, is still high, which is higher than the average level of the whole province and the whole country in the same period. Mastering the spatial distribution characteristics and risk factors of pulmonary tuberculosis is very important for effective prevention and control of related epidemics. This study explored the spatial-temporal distribution characteristics of pulmonary tuberculosis epidemic in Zhaotong City by using spatio-temporal scanning statistics, and found out the aggregation areas. Logistic regression model was used to analyze the occurrence of pulmonary tuberculosis aggregation. In the end, the medical behavior of pulmonary tuberculosis patients among individual behavior factors was studied, and the influencing factors of pulmonary tuberculosis epidemic situation in Yunnan Province were discussed in detail, which provided reference for formulating tuberculosis prevention and control strategy, improving prevention and control measures, optimizing resource allocation and so on. The main research methods and results are as follows: The first part is the study on the spatial-temporal distribution of tuberculosis cases in northeastern Yunnan Province. This study used time series and time-space scanning statistics to detect the spatial-temporal aggregation characteristics of tuberculosis cases in Zhaotong from 2011 to 2015. The time distribution shows a clear seasonal trend, the peak of incidence occurs mostly in winter, and the registration peak occurs in spring. The total registration rate of tuberculosis in Zhaotong City identifies one most likely cluster area and six secondary clusters, and the initial treatment registration rate has one most likely cluster area and five secondary clusters. The most likely areas of the three indicators are located in Zhenxiong County in the southeast of Zhaotong City. Zhenxiong County has a large population and lags behind the social and economic development. It is a priority area for tuberculosis control work. Part two: Influencing factors of spatial aggregation of tuberculosis in northeastern Yunnan Province. In this study, 11 active pulmonary tuberculosis patients who visited Zhaotong CDC from October 2015 to February 2016 were selected as the subjects. The aggregation of pulmonary tuberculosis was investigated by logistic regression analysis of the biological factors, personal behavior factors, social and economic conditions, environmental factors and so on. The results showed that the independent factors related to the spatial agglomeration area were chronic bronchitis, living in urban areas, smoking, and using coal as the main fuel for cooking and heating at home, suggesting that the prevention and control measures of tuberculosis in Zhaotong City should focus on such populations. A questionnaire survey was conducted among the registered pulmonary tuberculosis patients in Zhaotong from October 2015 to February 2016. The results showed that the patients'knowledge about tuberculosis was not comprehensive enough, and only one of the respondents was involved in the survey. 55.0% knew the policy of tuberculosis examination and treatment in China.Compared with the patients outside the agglomeration area, the patients in the agglomeration area had a longer time delay in diagnosis and more choice to go to the primary medical institutions for treatment. The number of retreats, the registration rate of tuberculous pleurisy and tuberculous pleurisy were higher, the proportion of patients supervised during the whole course was lower, and the medical staff were mostly family members.
【學位授予單位】：中國疾病預(yù)防控制中心
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R521
【參考文獻】
相關(guān)期刊論文 前10條
1 路麗蘋;洪建軍;高謙;王偉炳;;上海松江2006-2011年新登記肺結(jié)核時空分布規(guī)律及影響因素[J];中華疾病控制雜志;2014年08期
2 李新旭;周曉農(nóng);王黎霞;;結(jié)核病空間分布特征及影響因素研究進展[J];中國公共衛(wèi)生;2014年01期
3 劉媛;王學高;劉美伶;楊尚波;蔣偉利;王偉炳;;江蘇省阜寧縣活動性肺結(jié)核病患者分子成簇與空間聚集研究[J];中華傳染病雜志;2013年08期
4 朱士玉;后永春;舒文;張國良;聶紹發(fā);陳偉;成詩明;許奕華;;中國四省市結(jié)核病發(fā)病危險因素研究[J];中華流行病學雜志;2013年02期
5 唐益;龔德華;白麗瓊;萬燕萍;范江靜;張傳芳;;湖南省2003—2011年活動性肺結(jié)核患者登記的空間分析[J];中國防癆雜志;2012年12期
6 吳來娃;嚴非;王偉;賈環(huán);沈鑫;梅建;;上海市肺結(jié)核患者直接醫(yī)療費用及經(jīng)濟負擔分析[J];中國防癆雜志;2012年10期
7 康萬里;鄭素華;;空間掃描統(tǒng)計在中國菌陽結(jié)核病分布中的應(yīng)用[J];中國衛(wèi)生統(tǒng)計;2012年04期
8 王黎霞;成詩明;陳明亭;趙雁林;張慧;姜世聞;何廣學;呂青;杜昕;陳偉;劉小秋;阮云洲;王勝芬;夏aa;于蘭;李峻;李雪;;2010年全國第五次結(jié)核病流行病學抽樣調(diào)查報告[J];中國防癆雜志;2012年08期
9 何志青;胡貴方;資青蘭;唐惠紅;龔芳;陳樹忠;雷宇;包婉玲;劉桂絲;;廣州市肺結(jié)核發(fā)病危險因素的調(diào)查研究[J];中國防癆雜志;2012年07期
10 王黎霞;;中國結(jié)核病防治工作現(xiàn)狀分析[J];中國公共衛(wèi)生;2012年04期
相關(guān)博士學位論文 前2條
1 馬麥卷;結(jié)核免疫應(yīng)答相關(guān)基因多態(tài)性與肺結(jié)核易感性的關(guān)聯(lián)研究[D];中國人民解放軍軍事醫(yī)學科學院;2012年
2 賈忠偉;結(jié)核病時空傳播模型與危險因素評估[D];北京郵電大學;2008年
相關(guān)碩士學位論文 前3條
1 金瑾;2010-2012年濟寧市肺結(jié)核空間流行病學研究[D];山東大學;2014年
2 山珂;肺結(jié)核發(fā)病空間聚集分布及影響因素研究[D];山東大學;2014年
3 路麗蘋;上海市松江區(qū)結(jié)核病時空傳播規(guī)律研究[D];復(fù)旦大學;2013年
，本文編號：2193921
本文鏈接：http://sikaile.net/jingjilunwen/jiliangjingjilunwen/2193921.html
最近更新
教材專著
