發(fā)布時間：2018-03-14 15:13

  本文選題：軍隊　切入點：乙型肝炎　出處：《中國人民解放軍軍事醫(yī)學科學院》2017年碩士論文　論文類型：學位論文

【摘要】：研究目的:本文擬通過2012~2016年軍隊乙型肝炎發(fā)病數(shù)據(jù)的分析,從時間、空間、人群等角度探索軍隊乙型肝炎發(fā)病的特征和規(guī)律,并對相關影響因素進行探討,對防控策略提出建議,為軍隊乙型肝炎的研究和防控提供參考。同時,通過構建ARIMA時間序列模型,對2017年軍隊乙型肝炎發(fā)病進行預測,為軍隊乙型肝炎防控策略的及時調(diào)整提供參考資料。研究方法:通過文獻綜述研究了解乙型肝炎的病原學和流行病學特征以及防治現(xiàn)狀。通過中國人民解放軍突發(fā)公共衛(wèi)生事件和傳染病疫情報告信息系統(tǒng)收集整理2012~2016年軍隊乙型肝炎發(fā)病的數(shù)據(jù)資料,利用EXCEL、SPSS 22.0等工具手段進行流行病學數(shù)據(jù)整理與分析,通過描述性研究對2012~2016年軍隊乙型肝炎流行特征進行分析。利用SAS 9.1.3構建2012~2016年軍隊乙型肝炎發(fā)病時間序列,并使用自相關法、偏自相關法、差分處理、極大似然估計、最小二乘法估計等手段逐步處理時間序列,構建ARIMA時間序列模型,對2017年軍隊乙型肝炎發(fā)病情況進行預測。研究結果:2012~2016年軍隊共報告乙型肝炎發(fā)病病例1401例,其中2012年、2013年、2014年、2015年、2016年發(fā)病病例分別為394例、313例、264例、259例和171例,乙型肝炎發(fā)病病例數(shù)呈逐年下降趨勢。2016年相較于2015年下降33.98%,下降幅度最大;2013年較2012年下降約20.56%,2014年較2013年下降約15.65%,下降幅度較大;而2015年較2014年小幅下降,下降約1.89%。乙型肝炎發(fā)病病例全年都存在,從2012~2016年五年的月累計發(fā)病數(shù)據(jù)看,5月病例最多,占總病例的構成比為11.78%,其次分別為3、4、6月,構成比分別為9.99%、9.85%和8.78%。其他各月報告病例占總病例的構成比均在7%上下,相對比較平穩(wěn)。而以3、4、5、6四個月報告病例相對較多。本研究1401例乙型肝炎病例中,男性占94.2%,女性占5.8%。平均年齡為39.73±17.24歲,從病例的年齡段來看,以20~29歲年齡段為最多,病例數(shù)為409例,其次分別為30~39、40~49、50~59歲年齡段,病例數(shù)分別為355、250、172例。20~49歲年齡段發(fā)病數(shù)占總病例的72.37%。從職別分布看,以現(xiàn)役干部和士兵為最多,分別為612例和559例,各占報告病例總數(shù)的43.68%和39.90%。其次為離退人員,共計有189例,占報告病例總數(shù)的13.49%。對現(xiàn)役干部和士兵這兩類乙型肝炎發(fā)病數(shù)較多的人群,從其年齡構成來看,30歲以下人群中現(xiàn)役干部52人,士兵392人,士兵占主體;而30歲以上人群中現(xiàn)役干部560人,士兵167人,現(xiàn)役干部占主體。2012~2016年五年間,現(xiàn)役干部、士兵、離退人員的發(fā)病數(shù)均呈下降態(tài)勢,離退人員發(fā)病下降態(tài)勢較平穩(wěn),以士兵發(fā)病下降態(tài)勢最為明顯,下降幅度最大�，F(xiàn)役干部、士兵乙型肝炎發(fā)病數(shù)隨月份波動變化十分明顯,變化規(guī)律十分一致,均在5月達到發(fā)病數(shù)的最高點,其中,戰(zhàn)士的發(fā)病數(shù)隨月份變化更大。從地域來看,本研究乙型肝炎累計發(fā)病數(shù)以中部戰(zhàn)區(qū)為最多,占軍隊總發(fā)病數(shù)的構成比為34.90%;其次為西部,占構成比為26.77%;南部、北部相互之間差別不大,構成比為16.99%和15.49%;東部發(fā)病數(shù)最低,僅占軍隊總發(fā)病數(shù)的5.85%。從發(fā)病及診斷時間看,以入伍后5年內(nèi)乙型肝炎發(fā)病人數(shù)最多,而88.15%的人群在發(fā)病后一個月內(nèi)被診斷出,而64.60%的人群在發(fā)病后一周內(nèi)被診斷出。提取2012~2016年間軍隊乙型肝炎月發(fā)病數(shù)共60個數(shù)據(jù),創(chuàng)建時間序列,以建立ARIMA時間序列模型。平穩(wěn)性檢驗結果表明,該序列為非平穩(wěn)性時間序列,具有很顯然的趨勢性和季節(jié)性,在對序列進行6步差分和1次差分后,消除了序列的長期趨勢性影響和季節(jié)性趨勢影響,并通過平穩(wěn)性檢驗、白噪聲檢驗、模型構建、參數(shù)估計和模型檢驗,最終確定出ARIMA(0,1,1)?(0,1,1)6模型,殘差的白噪聲檢驗顯示為白噪聲序列,說明模型建立比較成功,具有較好的擬合度。使用ARIMA(0,1,1)?(0,1,1)6模型對軍隊2017年1~12月乙型肝炎發(fā)病情況進行預測,預測結果顯示,預測的2017年各月發(fā)病數(shù)相較于2016年的實際發(fā)病數(shù)均有較大程度的下降,2017年4、5、6三個月預測發(fā)病數(shù)高于其他各月,其中以5月的預測發(fā)病數(shù)為最多�？傮w來看,預測2017年軍隊乙型肝炎發(fā)病繼續(xù)保持下降趨勢,且仍存在一定的季節(jié)性差異。已掌握的2017年1~4月報告病例數(shù)據(jù)與預測結果較為接近,且均位于置信區(qū)間,顯示出較好的預測效果。研究結論:軍隊乙型肝炎發(fā)病總體呈下降態(tài)勢,以2016年下降幅度最大,士兵群體是乙型肝炎發(fā)病下降最為明顯的群體。軍隊肝炎發(fā)病以現(xiàn)役干部和士兵為主,在5月及其前后發(fā)病較多,體現(xiàn)出較為明顯的季節(jié)性差異,發(fā)病多為20~49歲青壯年人群,中西部戰(zhàn)區(qū)發(fā)病高于其他區(qū)域,而以東部戰(zhàn)區(qū)發(fā)病最低。ARIMA(0,1,1)?(0,1,1)6模型預測2017年軍隊乙型肝炎發(fā)病呈繼續(xù)下降趨勢,并帶有一定的季節(jié)性差異。乙型肝炎疫苗在軍隊乙型肝炎的防控中起到了重要的作用,需繼續(xù)加強易感人群和免疫失效人群的及時接種和補種,加強疫情監(jiān)測、傳染源管控和乙型肝炎防治培訓教育。加強對乙型肝炎患者的積極治療干預和監(jiān)督管控,以及對部隊衛(wèi)生機構乙型肝炎診療技術培訓,以便及時診斷并展開有針對性的治療。充分利用ARIMA時間序列模型進行疫情預測,提高軍隊乙型肝炎防控能力,及時調(diào)整軍隊乙型肝炎防控策略。
[Abstract]:Objective: This paper through the 2012~2016 forces of hepatitis B incidence data analysis, from the time, space, people explored characteristics and rules of the army the incidence of hepatitis B, and related factors were discussed, put forward suggestions on the prevention and control strategies, to provide reference for the study of hepatitis B prevention and control forces. At the same time, through the construction of ARIMA time series model to predict the incidence of hepatitis B in the army in 2017, to provide reference for the timely adjustment of strategy for prevention and control of hepatitis B army. Methods: To investigate the hepatitis B the pathogenic and epidemiological characteristics and prevention status by literature review. Through the Chinese people's Liberation Army public health emergencies and infectious disease reporting information collection system finishing 2012~2016 in the army of hepatitis B incidence data, using EXCEL SPSS 22 tools for epidemiology The data collection and analysis, through the descriptive research analysis on the epidemic characteristics of hepatitis B in army 2012~2016 years. Using SAS 9.1.3 to construct the 2012~2016 annual incidence of hepatitis B and the army time sequence, using the autocorrelation method, partial autocorrelation method, differential treatment, maximum likelihood estimation, least squares estimation by means of time series, the construction time of ARIMA sequence model to predict the incidence of hepatitis B in the army in 2017. Results: 2012~2016 forces were reported in the incidence of patients with hepatitis B in 1401 cases, which in 2012, 2013, 2014, 2015, 2016 cases were 394 cases, 313 cases, 264 cases, 259 cases and 171 cases, the incidence of cases of hepatitis B number increased year by year.2016 year downward trend compared to 2015 fell 33.98%, the largest decline; 2013 decreased by about 20.56% compared with 2012, 2014 decreased by about 15.65% compared to 2013, decreased greatly; and 201 5 years declined slightly compared to 2014, a decline of about 1.89%. of hepatitis B incidence cases are present throughout the year, from the years 2012~2016 five month cumulative incidence data, May in most cases, a total of cases is 11.78%, followed by 3,4,6 months, accounted for 9.99%, 9.85% and 8.78%. in the cases report the total cases were in 7%, relatively stable. In 3,4,5,6 four months reported relatively more. In this study, 1401 cases of hepatitis B cases, accounted for 94.2% of men, women accounted for 5.8%., the average age was 39.73 + 17.24 years old, from the age of patients, with 20~29 years of age is the most the number of cases, 409 cases, followed by 30~39,40~49,50~59 years of age, the number of cases were total 355250172 cases of.20~49 years of age the incidence of 72.37%. distribution from the ranks, with active cadres and soldiers for the most, respectively 612 and 559 All cases, accounted for the total number of reported cases and 43.68% 39.90%. followed by retired personnel, a total of 189 cases, accounting for the total number of reported cases of 13.49%. on active duty officers and soldiers of the two kinds of hepatitis B incidence number of people from the age of population under the age of 30 in active cadres 52 people, 392 soldiers. The soldiers occupied the main body; and 30 years of age or older active cadres 560 people, 167 soldiers, active cadres accounted for the main.2012~2016 five years, active cadres, soldiers from the number of cases of retired personnel showed a downward trend, declining incidence of retired workers is relatively stable, with a decreased incidence of soldiers trend is most obvious decline the largest. Active cadres, soldiers with the number of hepatitis B incidence month fluctuations obviously, changes are very consistent and reached the highest point, the incidence in May the incidence of soldiers with monthly changes greater. From the geographical point of view, this study The cumulative incidence of hepatitis B by central theater for the most, accounted for the army total incidence ratio of 34.90%; followed by the west, proportion is 26.77%; the southern, northern mutual difference, the ratio was 16.99% and 15.49%; the eastern incidence is lowest, only the number of troops total disease incidence and from 5.85%. the diagnosis at a time, 5 years after the army in the number of the highest incidence of hepatitis B, and 88.15% of the population in the incidence within one month after being diagnosed, and 64.60% of the population in the onset within one week after being diagnosed with hepatitis B during 2012~2016. The extraction forces a total of 60 month incidence data sequence to create time the ARIMA time series model. The stationary test results show that the sequence of non-stationary time series, with trend and seasonal obviously, in the 6 step difference and the 1 difference of sequence, eliminating the sequence of the long term trend and influence The seasonal trend of influence, and through the stationary test, white noise test, model construction, parameter estimation and model test, determined the ARIMA (0,1,1)? (0,1,1) 6 model, white noise test residual display as white noise series shows that the established model is more successful, have better fitting degree. (ARIMA 0,1,1)? (0,1,1) model to predict the army 6 2017 1~12 months of hepatitis B incidence, the prediction results show that, the predicted drop in every month of 2017 compared to 2016, the incidence of the actual number of cases have a higher degree of 4,5,6 in 2017 three months forecast incidence is higher than that in other months, the forecast incidence of May most. Overall, predicting the incidence of hepatitis B in 2017 the army continued to decline, and there is a seasonal difference. 1~4 months of 2017 reported data and predicted results have been relatively close, and are located in the The confidence interval, shows good prediction effect. Conclusion: the overall research of hepatitis B incidence showed a trend of decline, the largest decline in 2016, the soldier group is hepatitis B incidence decreased significantly in the groups. The army officers and soldiers with active hepatitis, in May before and after incidence more reflect the seasonal difference is obviously, the more the incidence among people aged between 20~49, the Midwest theater incidence is higher than that of other regions, and in the eastern theater of the lowest incidence of.ARIMA (0,1,1)? (0,1,1) prediction of hepatitis B disease in 2017 the army was to continue to decline in the 6 model, and with the seasonal variation. The hepatitis B vaccine plays an important role in the prevention and control of hepatitis B in the army, we need to strengthen the susceptible population and immune failure timely vaccination and vaccination, strengthen surveillance, prevention and control of infectious source of hepatitis B. Strengthen the training of education. In patients with hepatitis B positive intervention and supervision and control, as well as the military health organization diagnosis and treatment of hepatitis B and technical training, so that timely diagnosis and targeted treatment. Make full use of the ARIMA model of time series prediction, improve the hepatitis B prevention and control capacity, timely adjustment of military strategy for prevention and control of hepatitis B.

【學位授予單位】：中國人民解放軍軍事醫(yī)學科學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R824

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本文編號：1611754