【摘要】：研究背景 受艾滋病疫情發(fā)展速度和地區(qū)社會條件等因素的影響,艾滋病疫情在地理分布上明顯不均衡。正確認(rèn)識我國艾滋病報(bào)告疫情的空間分布,并進(jìn)一步根據(jù)實(shí)際情況合理地劃分亞流行區(qū),對艾滋病防治工作有重要的指導(dǎo)意義。 研究目的 分析我國艾滋病報(bào)告病例的空間聚集性及其變化趨勢；探討與我國艾滋病報(bào)告疫情地區(qū)差異性分布相關(guān)的社會宏觀因素；根據(jù)我國不同地區(qū)艾滋病流行水平和特點(diǎn),對所有省份劃分亞流行區(qū),為分類指導(dǎo)艾滋病防治工作提供信息和依據(jù)。 研究方法 收集我國1985年至2011年底歷年發(fā)現(xiàn)并報(bào)告的艾滋病病毒感染者或艾滋病病人(HIV/AIDS)的數(shù)據(jù)信息,各省份經(jīng)濟(jì)、人口和衛(wèi)生等社會因素?cái)?shù)據(jù)資料。首先,分別在省份水平和縣區(qū)水平利用時空掃描統(tǒng)計(jì)量法和空間自相關(guān)分析方法分析艾滋病報(bào)告病例聚集性分布的時間和空間及其變遷情況。然后,利用主成分分析方法提取社會宏觀因素綜合變量,利用兩水平負(fù)二項(xiàng)分布模型分析縣區(qū)艾滋病報(bào)告現(xiàn)患率與省份社會宏觀因素的關(guān)系。最后,將反映各省份艾滋病早期流行情況、流行擴(kuò)散與發(fā)展、現(xiàn)階段流行程度以及社會宏觀因素的若干變量納入聚類分析方法,在省份水平劃分亞流行區(qū)。 研究結(jié)果 1.省份水平和縣區(qū)水平的空間分析均發(fā)現(xiàn),截至每年報(bào)告病例均存在顯著聚集性且聚集區(qū)域不斷變化。1995年到2003年疫情從云南、新疆等地向中部地區(qū)擴(kuò)散,聚集性降低(全局Moran's I值0.1596,Z=15.9926,P0.05),但從2005年開始,西南地區(qū)的報(bào)告疫情又占優(yōu)勢,聚集性再次加強(qiáng)。分不同傳播途徑分析后發(fā)現(xiàn),注吸和異性途徑病例主要集中于云南、廣西和新疆等省份；采血途徑病例主要聚集于2004年的中原省份；同性途徑病例發(fā)生聚集時間較晚(2008至2011年),聚集區(qū)域較為分散,多屬經(jīng)濟(jì)較發(fā)達(dá)地區(qū)。 2.兩水平負(fù)二項(xiàng)分布模型分析發(fā)現(xiàn),水平2(省份)單位下各水平1(縣區(qū))單位的艾滋病報(bào)告現(xiàn)患率存在聚集性,即調(diào)整性別和年齡因素后,各省份間艾滋病報(bào)告現(xiàn)患率仍存在顯著差異(σu20。=2.612,P0.05)。納入水平2的社會宏觀因素變量進(jìn)行單因素和多因素分析均發(fā)現(xiàn),人口流動水平高或經(jīng)濟(jì)生活水平低(N3)、少數(shù)民族人口比例高(M4)、HIV篩檢人次數(shù)多(M5)與艾滋病報(bào)告現(xiàn)患率呈正相關(guān)(P0.05)。 3.綜合艾滋病流行早期情況、流行擴(kuò)散與發(fā)展速度、現(xiàn)流行階段總體疫情以及社會宏觀影響因素社四個方面共13個變量特征,將31個省份劃分為A、B、C三大類亞流行區(qū)。亞流行區(qū)A疾病負(fù)擔(dān)最重,截至2011年底全人群報(bào)告患病率9.3/萬人；早期疫情覆蓋范圍已較廣,且存在明顯聚集性流行；近年來艾滋病報(bào)告病例數(shù)平均發(fā)展速度最慢,截至2011年底包含了全國縣區(qū)水平75.4%的熱點(diǎn)縣區(qū)；經(jīng)濟(jì)生活水平最低。B區(qū)疫情屬中等水平(1.8/萬人)；早期流行以異性傳播途徑為主,1995年至2005年報(bào)告病例在縣區(qū)水平地理空間內(nèi)擴(kuò)散最快,近年報(bào)告病例數(shù)的上升速度也較快,截至2011年底占全部同性途徑熱點(diǎn)縣區(qū)的50.0%；經(jīng)濟(jì)生活水平和人口流動水平最高。C區(qū)包含14個省份,雖病例在縣區(qū)間的擴(kuò)散速度和近年報(bào)告病例數(shù)的發(fā)展速度均處于較高水平,但由于總體疫情水平低,其對全國疫情貢獻(xiàn)仍較小(0.8/萬人)。 研究結(jié)論 我國艾滋病不同流行時期具有不同的地理空間分布特征,各省艾滋病流行特點(diǎn)各異；并且,各地區(qū)艾滋病流行形勢與其社會宏觀因素密切相關(guān)。綜合考慮各省份艾滋病流行水平差異和地區(qū)的社會背景,進(jìn)行亞流行區(qū)的化分更科學(xué),突出各亞流行區(qū)獨(dú)特的疫情流行模式,有利于針對性開展分類防治工作。
[Abstract]:Research background
Influenced by the development speed of AIDS epidemic and regional social conditions, the geographical distribution of AIDS epidemic is obviously unbalanced. It is of great significance to understand the spatial distribution of reported AIDS epidemic in China and to divide sub-epidemic areas rationally according to the actual situation.
research objective
To analyze the spatial clustering and changing trend of reported AIDS cases in China; to explore the social macro-factors related to the regional differential distribution of reported AIDS cases in China; to divide all provinces into sub-epidemic areas according to the epidemic level and characteristics of AIDS in different regions of China, so as to provide information and guidance for the prevention and treatment of AIDS by classification. Basis.
research method
To collect the data of HIV/AIDS patients found and reported in China from 1985 to the end of 2011, and the data of economic, demographic and health factors in various provinces. Firstly, the spatial-temporal scanning statistics and spatial autocorrelation analysis were used to analyze AIDS at provincial and county levels respectively. Then, the comprehensive variables of social macro-factors were extracted by principal component analysis, and the relationship between the prevalence rate of AIDS reports in county and social macro-factors in province was analyzed by two-level negative binomial distribution model. Several variables of epidemic spread and development, current epidemic degree and social macro-factors are included in the cluster analysis method, and sub-epidemic areas are divided at the provincial level.
Research results
1. Spatial analysis at the provincial and county levels showed that the reported cases had significant aggregation and the aggregation areas were constantly changing. From 1995 to 2003, the epidemic spread from Yunnan and Xinjiang to the central region, and the aggregation decreased (global Moran's I value 0.1596, Z = 15.9926, P 0.05), but from 2005, the reported epidemic in southwest China began. According to the analysis of different transmission routes, the cases of injection-inhalation and heterosexual routes were mainly concentrated in Yunnan, Guangxi and Xinjiang provinces; the cases of blood collection routes were mainly concentrated in the Central Plains in 2004; the cases of homosexual routes occurred late (2008-2011), and the aggregation areas were scattered, mostly belonging to the genus. Economically developed areas.
2. Two-level negative binomial distribution model analysis found that the level 2 (provincial) units of the level 1 (county) unit of the current prevalence of AIDS report there is an aggregation, that is, adjusted for gender and age factors, the prevalence of AIDS report among provinces still exists significant differences (u20. = 2.612, P 0.05). The social macro-factors included in Level 2 variables for a single. Factors and multivariate analysis showed that high level of population mobility or low economic living standard (N3), high proportion of ethnic minorities (M4), and high number of HIV screening (M5) were positively correlated with the prevalence of AIDS (P 0.05).
3. According to the early epidemic situation, epidemic spread and development speed, the epidemic situation and the social macro-influencing factors, there are 13 variables in the epidemic stage. Thirty-one provinces are divided into three sub-epidemic areas: A, B and C. Epidemic coverage has been wider, and there is a significant clustering epidemic; in recent years, the average rate of development of AIDS cases is the slowest, including 75.4% of the country's county level by the end of 2011 hot counties; the lowest economic living standard. District B epidemic is a medium level (18/10000); the early epidemic mainly heterosexual transmission routes, 1995 By the end of 2011, 50.0% of all hotspot counties had been reported in the same sex routes. The economic living standard and the level of population mobility were the highest. District C included 14 provinces, although the rate of case spread in the county and the number of reported cases in recent years were fast. The rate of development is at a high level, but its contribution to the national epidemic situation is still small (0.8/10000) due to the low level of the overall epidemic situation.
research conclusion
There are different geographical and spatial distribution characteristics in different epidemic periods of AIDS in China, and the epidemic characteristics of AIDS in different provinces are different. Moreover, the epidemic situation of AIDS in different regions is closely related to its social macro-factors. The unique epidemic patterns of sub epidemic areas are conducive to targeted prevention and control.
【學(xué)位授予單位】：中國疾病預(yù)防控制中心
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R512.91

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