2012～2016年军队乙型肝炎流行特征分析及疫情预测研究

发布时间：2018-03-14 15:13

  本文选题：军队　切入点：乙型肝炎　出处：《中国人民解放军军事医学科学院》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:本文拟通过2012~2016年军队乙型肝炎发病数据的分析,从时间、空间、人群等角度探索军队乙型肝炎发病的特征和规律,并对相关影响因素进行探讨,对防控策略提出建议,为军队乙型肝炎的研究和防控提供参考。同时,通过构建ARIMA时间序列模型,对2017年军队乙型肝炎发病进行预测,为军队乙型肝炎防控策略的及时调整提供参考资料。研究方法:通过文献综述研究了解乙型肝炎的病原学和流行病学特征以及防治现状。通过中国人民解放军突发公共卫生事件和传染病疫情报告信息系统收集整理2012~2016年军队乙型肝炎发病的数据资料,利用EXCEL、SPSS 22.0等工具手段进行流行病学数据整理与分析,通过描述性研究对2012~2016年军队乙型肝炎流行特征进行分析。利用SAS 9.1.3构建2012~2016年军队乙型肝炎发病时间序列,并使用自相关法、偏自相关法、差分处理、极大似然估计、最小二乘法估计等手段逐步处理时间序列,构建ARIMA时间序列模型,对2017年军队乙型肝炎发病情况进行预测。研究结果:2012~2016年军队共报告乙型肝炎发病病例1401例,其中2012年、2013年、2014年、2015年、2016年发病病例分别为394例、313例、264例、259例和171例,乙型肝炎发病病例数呈逐年下降趋势。2016年相较于2015年下降33.98%,下降幅度最大;2013年较2012年下降约20.56%,2014年较2013年下降约15.65%,下降幅度较大;而2015年较2014年小幅下降,下降约1.89%。乙型肝炎发病病例全年都存在,从2012~2016年五年的月累计发病数据看,5月病例最多,占总病例的构成比为11.78%,其次分别为3、4、6月,构成比分别为9.99%、9.85%和8.78%。其他各月报告病例占总病例的构成比均在7%上下,相对比较平稳。而以3、4、5、6四个月报告病例相对较多。本研究1401例乙型肝炎病例中,男性占94.2%,女性占5.8%。平均年龄为39.73±17.24岁,从病例的年龄段来看,以20~29岁年龄段为最多,病例数为409例,其次分别为30~39、40~49、50~59岁年龄段,病例数分别为355、250、172例。20~49岁年龄段发病数占总病例的72.37%。从职别分布看,以现役干部和士兵为最多,分别为612例和559例,各占报告病例总数的43.68%和39.90%。其次为离退人员,共计有189例,占报告病例总数的13.49%。对现役干部和士兵这两类乙型肝炎发病数较多的人群,从其年龄构成来看,30岁以下人群中现役干部52人,士兵392人,士兵占主体;而30岁以上人群中现役干部560人,士兵167人,现役干部占主体。2012~2016年五年间,现役干部、士兵、离退人员的发病数均呈下降态势,离退人员发病下降态势较平稳,以士兵发病下降态势最为明显,下降幅度最大。现役干部、士兵乙型肝炎发病数随月份波动变化十分明显,变化规律十分一致,均在5月达到发病数的最高点,其中,战士的发病数随月份变化更大。从地域来看,本研究乙型肝炎累计发病数以中部战区为最多,占军队总发病数的构成比为34.90%;其次为西部,占构成比为26.77%;南部、北部相互之间差别不大,构成比为16.99%和15.49%;东部发病数最低,仅占军队总发病数的5.85%。从发病及诊断时间看,以入伍后5年内乙型肝炎发病人数最多,而88.15%的人群在发病后一个月内被诊断出,而64.60%的人群在发病后一周内被诊断出。提取2012~2016年间军队乙型肝炎月发病数共60个数据,创建时间序列,以建立ARIMA时间序列模型。平稳性检验结果表明,该序列为非平稳性时间序列,具有很显然的趋势性和季节性,在对序列进行6步差分和1次差分后,消除了序列的长期趋势性影响和季节性趋势影响,并通过平稳性检验、白噪声检验、模型构建、参数估计和模型检验,最终确定出ARIMA(0,1,1)?(0,1,1)6模型,残差的白噪声检验显示为白噪声序列,说明模型建立比较成功,具有较好的拟合度。使用ARIMA(0,1,1)?(0,1,1)6模型对军队2017年1~12月乙型肝炎发病情况进行预测,预测结果显示,预测的2017年各月发病数相较于2016年的实际发病数均有较大程度的下降,2017年4、5、6三个月预测发病数高于其他各月,其中以5月的预测发病数为最多。总体来看,预测2017年军队乙型肝炎发病继续保持下降趋势,且仍存在一定的季节性差异。已掌握的2017年1~4月报告病例数据与预测结果较为接近,且均位于置信区间,显示出较好的预测效果。研究结论:军队乙型肝炎发病总体呈下降态势,以2016年下降幅度最大,士兵群体是乙型肝炎发病下降最为明显的群体。军队肝炎发病以现役干部和士兵为主,在5月及其前后发病较多,体现出较为明显的季节性差异,发病多为20~49岁青壮年人群,中西部战区发病高于其他区域,而以东部战区发病最低。ARIMA(0,1,1)?(0,1,1)6模型预测2017年军队乙型肝炎发病呈继续下降趋势,并带有一定的季节性差异。乙型肝炎疫苗在军队乙型肝炎的防控中起到了重要的作用,需继续加强易感人群和免疫失效人群的及时接种和补种,加强疫情监测、传染源管控和乙型肝炎防治培训教育。加强对乙型肝炎患者的积极治疗干预和监督管控,以及对部队卫生机构乙型肝炎诊疗技术培训,以便及时诊断并展开有针对性的治疗。充分利用ARIMA时间序列模型进行疫情预测,提高军队乙型肝炎防控能力,及时调整军队乙型肝炎防控策略。
[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.

【学位授予单位】：中国人民解放军军事医学科学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R824

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本文编号：1611754