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2004—2020年中国甲肝和乙肝发病趋势贝叶斯年龄–时期–出生队列分析

Bayesian age-period-cohort analysis of hepatitis A and B incidence trends in China, 2004–2020

    摘要
  • 摘要:
    目的 分析中国甲肝和乙肝发病趋势变化，为科学防控提供依据。
    方法 自公共卫生科学数据中心收集中国大陆31个省（自治区、直辖市）2004—2020年甲肝和乙肝发病数据。利用joinpoint回归、贝叶斯年龄–时期–出生队列（Bayesian Age-Period-Cohort，BAPC）模型分别对甲肝、乙肝总体趋势、年龄特征、时期特征和出生队列特征进行分析。
    结果 2004—2020年甲肝总体呈下降趋势（AAPC= –11.23%，95%CI= –13.32%～–9.09%），其中2004—2012年（EAPC= –15.47%，95%CI= –18.57%～–12.24%）、2012—2020年（EAPC= –6.79%，95%CI= –10.21%～–3.23%）甲肝均呈下降趋势。2004—2020年乙肝总体无明显趋势变化（AAPC= –0.43%，95%CI= –2.95%～2.17%）。2004—2020年全国甲肝总体发病率以5～9岁（71 223例，5.34/10万）、0～4岁（53 493例，3.92/10万）、10～14岁（48 481例，3.49/10万）年龄组最高；甲肝高发年龄由2004年低年龄组（≤14岁）转向2017年后的高年龄组（≥75岁）。2004—2020年全国乙肝总体发病率以25～29岁（1 981 536例，114.46/10万）、30～34岁（1 878 450例，110.13/10万）、50～54岁（1 500 335例，99.61/10万）年龄组最高；乙肝高发年龄由2004年15～24岁年龄组转向2016年后的50～59岁年龄组。甲肝出生队列发病风险呈倒“V”型，2000年后出生人群发病风险逐年下降（P<0.05）。乙肝出生队列发病风险呈倒“V”型，1995年后出生人群发病风险逐年下降（P<0.05）。
    结论 我国甲肝疫苗、乙肝疫苗纳入扩大免疫规划（EPI）后，目标人群发病率明显下降；2004—2020年我国甲肝、乙肝高发人群均出现了明显变化，高发年龄均出现向高年龄组转移的趋势。

     

    Abstract:
    Objective To analyze the trends in hepatitis A (HA) and hepatitis B (HB) incidence in China and provide evidence for scientific prevention and control.
    Methods Data on HA and HB incidence from 2004 to 2020 were collected from the Public Health Science Data Center for 31 provinces (autonomous regions and municipalities) in China′s mainland . Joinpoint regression and Bayesian Age-Period-Cohort (BAPC) models were used to analyze the overall trends, age, period, and birth cohort effects of HA and HB.
    Results The overall incidence of HA showed a decreasing trend from 2004 to 2020 (AAPC= –11.23%, 95%CI: –13.32% to –9.09%), with decreasing trends observed in both 2004–2012 (EAPC= –15.47%, 95%CI: –18.57% to –12.24%) and 2012–2020 (EAPC= –6.79%, 95%CI: –10.21% to –3.23%). The overall incidence of HB showed no significant trend from 2004 to 2020 (AAPC= –0.43%, 95%CI: –2.95%–2.17%). From 2004 to 2020, the highest HA incidence rates were observed in the 5–9 (71 223 cases, 5.34/100 000), 0–4 (53 493 cases, 3.92/100 000), and 10-14 (48 481 cases, 3.49/100 000) age groups. The age group with the highest HA incidence shifted from younger age groups (≤14 years) in 2004 to older age groups (≥75 years) after 2017. From 2004 to 2020, the highest HB incidence rates were observed in the 25–29 (1 981 536 cases, 114.46/100 000), 30–34 (1 878 450 cases, 110.13/100 000), and 50–54 (1 500 335 cases, 99.61/100 000) age groups. The age group with the highest HB incidence shifted from the 15–24 age group in 2004 to the 50–59 age group after 2016. The birth cohort risk of HA showed an inverted "V" shape, with a decreasing trend in those born after 2000 (P<0.05). The birth cohort risk of HB also showed an inverted "V" shape, with a decreasing trend in those born after 1995 (P<0.05).
    Conclusions After the inclusion of HA and HB vaccines in the Expanded Program on Immunization (EPI) in China, the incidence rates in the target populations have decreased significantly. From 2004 to 2020, significant changes were observed in the high-risk populations for both HA and HB, with a trend towards higher age groups.

     

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